Novel Lithotripsy-Assisted Transcatheter Aortic Valve Replacement May Reduce Risk of Aortic Root Rupture

Severe calcific aortic stenosis (AS) can be successfully treated with transcatheter aortic valve replacement (TAVR) using both balloon-expandable valves (BEV) and self-expanding valves. Challenges remain for treatment of AS with TAVR in relation to the severity of calcification involving valve leaflets, aortic annulus, and/or left ventricular outflow tract. Severe calcification presents challenges to TAVR with respect to aortic root/annular rupture and risk for peri-valve leak (PVL).

Three separate patients with symptomatic severe AS and severely calcified valves underwent TAVR with BEV. Case 1 underwent TAVR without preceding intravascular lithotripsy (IVL) of the native valve and developed annular rupture requiring surgical rescue. Following this experience, TAVR in 2 subsequent cases was preceded by Shockwave IVL using a novel 12-mm × 30-mm L6 balloon placed across the native valve prior to BEV implantation.

Following IVL, cases 2 and 3 had uncomplicated TAVR with excellent valve frame expansion, and no significant residual gradient or PVL.

Severely calcified aortic valves increase the risk of aortic annular rupture and PVL following TAVR. IVL prior to TAVR may enhance leaflet/ annular compliance with the potential to improve the safety and effectiveness of TAVR.