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Novel percutaneous intervention technique for obstructed coronary artery after valve-in-valve transcatheter aortic

Kentaro Mitsui1,2, Kensuke Takagi1, Takashi Kakuta3

  • 1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|October 19, 2023
PubMed

Insights

A novel "Whisker pole guiding technique" offers a simple bailout solution for coronary obstruction following valve-in-valve transcatheter aortic valve replacement (ViV TAVR). This method effectively restores coronary flow when standard protection strategies fail.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) is a procedure to replace a failing aortic valve with a new prosthetic valve delivered via catheter.
  • Coronary obstruction is a known complication of ViV TAVR, potentially leading to myocardial infarction.
  • Existing coronary protection strategies are widely used, but bailout techniques for managing obstruction are less established.

Observation:

  • A patient undergoing ViV TAVR experienced prosthetic valve migration, causing severe (90%) stenosis in the left anterior descending coronary artery and impaired coronary flow.
  • Standard coronary protection measures were insufficient to address the acute coronary obstruction.
  • A novel technique was employed using a guide-extension catheter to reposition the Judkins right guiding catheter (JR) for improved coronary artery engagement.

Findings:

  • The
  • Whisker pole guiding technique
  • successfully restored coronary artery access and flow after ViV TAVR.
  • This technique involves using a guide-extension catheter to create a stable backup for the guiding catheter, facilitating engagement of the coronary artery.
  • The procedure was performed after balloon dilation between the prosthetic valve and aorta, enabling the JR to engage the coronary artery with excellent backup.

Implications:

  • This technique provides a valuable and simple bailout option for managing coronary obstruction during or after ViV TAVR.
  • It may reduce the risk of adverse cardiac events associated with coronary obstruction in ViV TAVR procedures.
  • Further studies are warranted to evaluate the broader applicability and long-term outcomes of this novel technique in interventional cardiology.

Keywords:
ACS/NSTEMIcoronary artery diseaseheart diseasevalvular

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