Transcatheter Aortic Valve Implantation with the Edwards Sapien XT Valve

- Operator : Seung-Jung Park

Transcatheter Aortic Valve Implantation with the Edwards Sapien XT Valve
- Operator: Seung-Jung Park, MD
Case Presentation
A 77 year-old woman was admitted for a year of dyspnea on exertion (NYHA class ¥²). She has a past medical history of hypertension, diabetes and hepatocellular carcinoma treated by trans-arterial chemoembolization. Her coronary angiogram showed mild CAD. Her logistic EuroSCORE was 5.46 %.
Echocardiographic Findings
  1. Transthoracic echocardiography showed severe degenerative aortic stenosis with preserved LV systolic function (EF = 63%). AV area by continuity equation was 0.55 cm©÷. Trans-AV peak velocity was 5.1 m/s. Mean and peak pressure gradient were 61 and 103 mmHg.
CT Findings
  1. Annulus size by CT was about 18.9-26.0 mm and perimeter was 69.7 mm (Figure 1).
  2. Distance from annulus to LM and RCA ostium was 12.1 and 15.4 mm, respectively (Figure 2). The lowest diameter of right femoral artery was 7.4 mm and there was no problem in vessel size and calcification (Figure 3).
Procedure
We selected the 23mm sized Edward Sapien XT valve. 6 Fr sheath and temporary pacemaker were inserted through left femoral vein, and 7 Fr sheath and 6 Fr pig-tail catheters 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 two 8 Fr Proglide devices were placed into the right femoral artery. After removal of the sheath, 18 Fr Edward E sheath was placed. And then, an AL 1 diagnostic catheter with a stiff wire was used to cross the aortic valve. After crossing AV, the stiff wire was replaced by a super-stiff wire, and then we did predilation using Edward transfemoral balloon 20 mm x 4 cm ( Movie 1). The Edward Sapien XT Novaflex Plus valve was crossed over AV using the super-stiff wire and deployment was done. Immediately after valve implantation, root angiography showed all coronary arteries was patent and minimal paravalvular regurgitation ( Movie 2). After the intervention, puncture site was sutured by prepared two Proglides.

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