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

[1]AbramowitzY, MaenoY, ChakravartyT, et al., 2016. Aortic angulation attenuates procedural success following self-expandable but not balloon-expandable TAVR. JACC Cardiovasc Imaging, 9(8):964-972.

[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.

[4]AnconaMB, HachinoheD, GianniniF, et al., 2018. Hypertrophic left ventricle with small cavity and severe aortic angulation: a dangerous association in case of transcatheter aortic valve replacement. JACC Cardiovasc Interv, 11(4):e29-e30.

[5]AraiT, RomanoM, LefèvreT, et al., 2016. Direct comparison of feasibility and safety of transfemoral versus transaortic versus transapical transcatheter aortic valve replacement. JACC Cardiovasc Interv, 9(22):2320-2325.

[6]EspinozaRueda MA, Muratalla GonzálezR, GarcíaGarcía JF, et al., 2021. Description of the step-by-step technique with snare catheter for TAVR in horizontal aorta. JACC Case Rep, 3(17):1811-1815.

[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.

[9]LeonMB, SmithCR, MackM, et al., 2010. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 363(17):‍1597-1607.

[10]NobleS, RoffiM, 2014. Retrograde aortic valve crossing of the corevalve prosthesis using the buddy balloon technique. Catheter Cardiovasc Interv, 84(6):897-899.

[11]OttoCM, NishimuraRA, BonowRO, et al., 2021. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 143(5):e35-e71.