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Extra-anatomic TAVI in a GUCH patient with a Rastelli channel
Gry Dahle, Gunnar Eriksen, Jon Offstad, Anders Hervold, Kjell Arne Rein.
Rikshospitalet, OUS, Oslo, Norway.

OBJECTIVE: An increasing number of grown ups with congenital heart defects (GUCH) are in need of secondary procedures. Sometimes a third or fourth sternotomy is needed. These are very complex procedures with abnormal anatomy. The transcatheter valve technology as well as imaging is evolving and ”custom made” extraanatomical procedures may be an alternative.
We present a 31 year old male with ASD,VSD,DORV, TGA and pulmonal atresia, gone through surgery three times before: GOBT-shunt, septalization of atrium and ventricle and re-routing of left ventricle to aorta (am Rastelli) with a Gore-tex patch, and last reconstruction of the RVOT as well as the aortic root am Yacoub. Now presenting with aortic regurgitationa and left ventricular dilatataion.
METHODS: CT images were segmented using the software from Materialise (Materialise, Loeven). Images were discussed for best performance in the process. After generating a STL (stero litography) file out of the patient data set, the image a 3D plaster modell was created.
The diameter of the native annulus was too large for a catheter valve on the market, but the subannular dimention was suitable for a cathetervalve.
The procedure was performed in a hybrid operation room in general anesthesia. With TEE and fluoroscopy guidance. No predilatation was done. An Edwards Sapien S3#26 was deployed transapically under rapid pacing. It was positioned below the anatomical aortic valve in the Rastelli channel. Apex was closed .
RESULTS: The control angio and echo showed good position and performance and no leak in the valve.
The patient was extubated in the operation room, discharged to local hospital on day 6.
CONCLUSIONS: This technique can be useful in complex anatomy redo heat surgery, especially in the growing polulation of GUCH patients, 3D print can be useful for planning, It may also postpone eventual need of heart transplantaion in this group.

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