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A CHALLENGING PERCUTANEOUS TRANSAXILLARY TAVR Flavien Vincent MD, - PowerPoint PPT Presentation

Jun 03, 2023 •153 likes •327 views

A CHALLENGING PERCUTANEOUS TRANSAXILLARY TAVR Flavien Vincent MD, PhD abcd ; Cdric Delhaye Md a ; Philippe Gnreux MD f ; Francis Juthier MD, PhD e , Richard Azzaoui, MD e ; Hugues Spillemaeker a , Eric Van Belle MD, PhD abcd a CHU Lille,

  1. A CHALLENGING PERCUTANEOUS TRANSAXILLARY TAVR Flavien Vincent MD, PhD abcd ; Cédric Delhaye Md a ; Philippe Généreux MD f ; Francis Juthier MD, PhD e , Richard Azzaoui, MD e ; Hugues Spillemaeker a , Eric Van Belle MD, PhD abcd a CHU Lille, Cardiologie interventionnelle, France; b Inserm, U1011, Lille, France; c Univ. Lille, U1011 - EGID, Lille, France; d Institut Pasteur de Lille, France; e CHU Lille, Chirurgie cardiaque et vasculaire, France; f Morristown medical center, NJ, USA & CRF, NY, USA 30-31 Janvier 1 er Février 2019

  2. 80 YO MALE, SEVERE AORTIC STENOSIS Right iliac : 3,5mm •LVEF 60% •CAD : PCI RCA & Cx (2015) •Atrial fibrillation •Chronic Kidney disease • Severe PAD: Left iliac : 3,2mm Hostile, calcified Calcified femoral anterior wall ++ femoral access 30-31 Janvier 1 er Février 2019

  3. SCREENING FOR ALTERNATIVE ACCESS : TOO SMALL CAROTID ARTERIES Right carotid : 3,0mm 30-31 Janvier 1 er Février 2019 Left carotid : 3,2mm

  4. SCREENING FOR ALTERNATIVE ACCESS : SUITABLE FOR LEFT TRANSAXILLARY ACCESS Anticipated issues : • Small diameter, subclavian tortuosity & clusters of calcifications • Suitable for Evolut R with In-line Sheath 30-31 Janvier 1 er Février 2019

  5. PERCUTANEOUS TRANSAXILLARY ACCESS • Axillary Angiography via 9 Fr Right femoral access • Safety 0,018 wire from right leg to left arm 30-31 Janvier 1 er Février 2019

  6. PERCUTANEOUS TRANSAXILLARY ACCESS • Angio / Fluo / Ultrasound-guided puncture 30-31 Janvier 1 er Février 2019

  7. PERCUTANEOUS TRANSAXILLARY ACCESS • X2 pre-closing w/ proglide • Valve crossing and predilatation with 14Fr sheath 30-31 Janvier 1 er Février 2019

  8. DIFFICULTIES FOR CROSSING SUBCLAVIAN TORTUOSITY Crossing difficulties with Boston Amplatz super stiff wire 30-31 Janvier 1 er Février 2019

  9. DIFFICULTIES FOR CROSSING SUBCLAVIAN TORTUOSITY Success after reorientation in-line Crossing difficulties with Boston sheath Amplatz super stiff wire 30-31 Janvier 1 er Février 2019

  10. DIFFICULTIES FOR CROSSING SUBCLAVIAN TORTUOSITY 30-31 Janvier 1 er Février 2019

  11. SAFETY WIRE PULLED OUT BY VALVE SHEATH • Wire gets dragged on by inline-sheath into ascending aorta • Risk of jailed wire after valve deployment • Risk of losing safety wire 30-31 Janvier 1 er Février 2019

  12. SAFETY WIRE PULLED OUT BY VALVE SHEATH JR4 to reduce slack and jump up the safety wire Successful Evolut R 29mm valve implantation 30-31 Janvier 1 er Février 2019

  13. DRY ARTERY CLOSURE � Inline sheath withdrawal protected by balloon tamponade � Percutaneous closure with proglide X2 30-31 Janvier 1 er Février 2019

  14. FINAL ANGIOGRAM • Final angio revealing subclavian artery dissection • Conservative management 30-31 Janvier 1 er Février 2019

  15. FOLLOW-UP • Normal Axillary & Subclavian Ultrasound exam • No further event 30-31 Janvier 1 er Février 2019

  16. TAKE HOME • Thorough planification mandatory • Require Basic peripheral skills • Safe (full percutaneous management if preclosing device failure) • Know the limits : Not for all (anatomic issues : obese, small diameter, extreme tortuosity and calcifications); Require 2 nd access • Reduce the threshold for alternative access • #1 alternative access in our team 30-31 Janvier 1 er Février 2019

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