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On-line Access: 2022-07-06

Received: 2021-10-08

Revision Accepted: 2022-01-06

Crosschecked: 2022-07-06

Cited: 0

Clicked: 109

Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Jian-an Wang

https://orcid.org/0000-0002-4583-3204

Xianbao LIU

https://orcid.org/0000-0003-1556-9198

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Journal of Zhejiang University SCIENCE B 2022 Vol.23 No.7 P.613-616

http://doi.org/10.1631/jzus.B2100860


Novel apical-to-femoral rail technique for horizontal aorta in transcatheter aortic valve replacement


Author(s):  Xianbao LIU, Hanyi DAI, Lihan WANG, Jiaqi FAN, Jian'an WANG

Affiliation(s):  Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; more

Corresponding email(s):   wangjianan111@zju.edu.cn

Key Words:  Transcatheter Aortic Valve Replacement, Aortic Stenosis, Horizontal Aorta, Apex-femoral Artery Rail


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Xianbao LIU, Hanyi DAI, Lihan WANG, Jiaqi FAN, Jian'an WANG. Novel apical-to-femoral rail technique for horizontal aorta in transcatheter aortic valve replacement[J]. Journal of Zhejiang University Science B, 2022, 23(7): 613-616.

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Abstract: 
transcatheter Aortic Valve Replacement (TAVR) has emerged as a viable treatment option for patients with severe aortic Stenosis regardless of its surgical risk stratification (Otto et al., 2021). Aortic angulation is usually measured as the angle between the horizontal and the aortic annulus planes based on preproced‍ural multidetector computed tomography (MDCT) (Al-Lamee et al., 2011). Extremely horizontal Aorta, defined as an aortic angulation greater than 70°, is an unfavorable anatomic structure that poses particular technical challenges for TAVR. Abramowitz et al. (2016) have proved that an extremely horizontal Aorta increased the risk of procedural complications, such as lower device success rates, more moderate or even severe perivalvular leakage (PVL), and the need for second valve implantation. Because of the long stent frame, inflexibility, and non-steerability, it is challenging to pass the delivery system of self-expanding valves (SEVs) through an extremely horizontal Aorta. As a result, patients with an extremely horizontal Aorta have always been excluded from the clinical trials of TAVR, and transfemoral (TF)-TAVR with SEV is considered as an "off-label" use of TAVR (Adams et al., 2014; Kaneko et al., 2020). Herein, we present a technically difficult case, in which a patient with an extremely horizontal Aorta underwent TF-TAVR with SEV by applying a unique apical-to-femoral rail strategy.

经导管主动脉瓣置换术中应用心尖-股动脉轨道技术治疗极度横位心主动脉瓣狭窄一例

刘先宝1,2,戴晗怡2,王力涵1,范嘉祺1,王建安1,2
1浙江大学附属第二医院心血管内科,中国杭州市,310009
2浙江大学医学院内科学,中国杭州市,310058
目的:为经导管主动脉瓣置换术中治疗极度横位心的主动脉瓣狭窄患者制定手术策略提供借鉴。
创新点:本研究的患者为老年女性,她被诊断为重度主动脉瓣狭窄,拟接受经导管主动脉瓣置换术。术前电子计算机断层扫描(CT)结果显示患者为主动脉瓣呈type 0型二叶式主动脉瓣,主动脉成角为84°,为极度横位心。术中我们通过建立心尖-股动脉轨道实现瓣膜同轴置入,术后病人无并发症发生。
方法:在左胸前外侧第五肋间切一小口,打开心包,经心尖引入圈套器,捕捉经右侧股动脉引入的超滑导丝并将其拉出体外,建立心尖-股动脉轨道。通过同时牵拉轨道的两端增加张力,调整输送系统的成角,实现球囊扩张及瓣膜同轴置入。
结论:使用经导管主动脉瓣置换术治疗主动脉瓣狭窄患者时,心尖-股动脉轨道技术是应对极度横位心的有效治疗策略。

关键词:经导管主动脉瓣置换术;主动脉瓣狭窄;极度横位心;心尖-股动脉轨道技术

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Reference

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[2]AdamsDH, PopmaJJ, ReardonMJ, et al., 2014. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med, 370(19):1790-1798.

[3]Al-LameeR, GodinoC, ColomboA, 2011. Transcatheter aortic valve implantation: current principles of patient and technique selection and future perspectives. Circ Cardiovasc Interv, 4(4):387-395.

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[7]FanJ, YuC, RenK, et al., 2021. Kidney function change after transcatheter aortic valve replacement in patients with diabetes and/or hypertension. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 22(3):241-247.

[8]KanekoU, HachinoheD, KobayashiK, et al., 2020. Evolut self-expanding transcatheter aortic valve replacement in patients with extremely horizontal aorta (aortic root angle≥70°). Int Heart J, 61(5):1059-1069.

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