Endoconduit for Transcatheter Aortic Valve Implantation
TAKASHI MURAKAMI, Hiromichi Fujii, Masahiro Sakaguchi, Yosuke Takahashi, Shinsuke Nishimura, Daisuke Yasumizu, Yoshito Sakon.
Osaka City University Graduate School of Medicine, Osaka, Japan.
OBJECTIVE: Access challenges are sometimes encountered in patients indicated for transcatheter aortic valve implantation (TAVI). Transapical access is a well-established alternative, but it is more invasive than the standard transfemoral access. We present the iliac endoconduit technique to perform transfemoral TAVI in two patient with small-caliber, heavily calcified iliac arteries.
METHODS: The procedure was performed in a fully equipped hybrid operating room. A 3-cm left inguinal incision was made, and the common femoral artery or the distal external iliac artery (EIA) was exposed. Two pieces of stent graft were deployed to cover the full length of EIA in one and from the common iliac to distal EIA in another patient. Then, controlled rupture of the iliac artery was conducted with an 8 to 10 mm balloon. Angiography did not revealed hemorrhage. The TAVI procedure was performed through this stent graft, or endoconduit.
RESULTS: Valve implantation was completed successfully, and the retrieval of the sheath was uneventful. Angiography showed no hemorrhage of the iliac arteries and that the stent graft was patent; however, it also revealed a small external iliac dissection distal to the edge of the stent graft in one and stenosis at the insertion site in another. Postoperative evaluation revealed patency of the conduit in both cases.
CONCLUSIONS: This technique could provide an adequate access route for TAVI from groin even in patients with prohibitory iliac anatomy.
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