Transcatheter aortic valve implantation with Edwards SAPIEN XT Valve

- Operator : Seung-Jung Park

Transcatheter aortic valve implantation with Edwards SAPIEN XT Valve

- Operator: Seung-Jung Park, MD

Case Presentation

A 85 years-old gentleman was admitted with dyspnea on exertion (NYHA class III). He has a past medical history of hypertension, dyslipidemia. His logistic EuroSCORE was 7.96%. His coronary angiography was normal.

Echocardiographic Findings

Transthoracic echocardiography showed severe degenerative AS, mild AR. But there was no regional wall motion abnormality and was concentric LVH with normal LV systolic function (EF=67%). AV area by continuity equation was 0.62 cm². TransAV maximal velocity was 5.8 m/s. Peak and mean pressure gradient were 135 and 75 mmHg.

CT Findings

Annulus size by CT was 21.6 - 28.8 mm and perimeter was 80.7mm and Annulus area was 490.3 mm2 (Figure 1). Distance from annulus to LM and RCA ostium was 17.8 and 15.3 mm, respectively. The lowest diameter of right femoral artery was 7.8 mm and there was no problem in vessel size and calcification (Figure 2, Figure 3, Figure 4).

Procedure

The annulus size by CT was 21.6 - 28.8 mm, perimeter was 80.7 mm. After discussion, we selected the 26mm Edwards SAPIEN XT valve for implantation. Under general anesthesia, 6 Fr sheath and temporary pacemaker were inserted through left femoral vein, and 7 Fr sheath and 6 Fr pig-tail catheter were inserted through left femoral artery. After right peripheral angiogram with pig-tail catheter, we checked proper puncture site of right femoral artery. 8 Fr sheath was inserted through right femoral artery, and then three 8 Fr Proglide devices were placed into the right femoral artery. After removal of the sheath, 18 Fr Edwards E-sheath was inserted. An AL 2 diagnostic catheter with a 0.035-inch stiff wire was used to cross the aortic valve. After crossing AV, the stiff wire was replaced by a 0.035-inch Lunderquist super-stiff wire, and then predilatation of the stenotic AV was undertaken with a 23 x 40 mm Edwards transfemoral balloon under rapid ventricular pacing and aortic root angiography ( Movie 1). Under fluoroscopy control, a 26-mm Edwards SAPIEN XT prosthesis crimped on the delivery catheter (NovaFlex Delivery System) was placed at the best position of the aortic annulus and then it was successfully deployed by inflating the balloon under rapid ventricular pacing and aortic root angiography ( Movie 2). Final fluoroscopy showed well positioned Edwards Valve ( Movie 3). After the removal of Edward 18 Fr sheath, we checked the right peripheral angiogram ( Movie 4), and the puncture site was sutured by prepared three Proglides.