Transcaval access for TAVR across a polyester aortic graft

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Transcaval access provides an alternative route for transcatheter aortic valve replacement (TAVR) when traditional access is not feasible.
• Closure of the aorto-caval fistula post-TAVR typically involves nitinol cardiac occluders.
• Previous literature lacks experience with transcaval access through synthetic aortic grafts.

Observation:

• A patient requiring TAVR had a history of aortic graft surgery, precluding standard access routes.
• Radiofrequency energy was utilized to facilitate guidewire traversal through a polyester aortic graft for retrograde venous access.
• A polyester-seeded nitinol ventricular septal defect occluder was implanted to close the aorto-caval fistula.

Findings:

• Successful transcaval access and TAVR were achieved through a polyester aortic graft.
• The described technique allowed for retrograde TAVR via the femoral vein.
• Initial residual aorto-caval fistulous flow resolved spontaneously within one month post-procedure.

Implications:

• This case expands the applicability of transcaval access for TAVR to patients with synthetic aortic grafts.
• The use of radiofrequency energy offers a potential solution for navigating prosthetic material during vascular access.
• Spontaneous closure of the aorto-caval fistula suggests favorable healing characteristics of the chosen occluder device.