Snare catheter technique in complex transcatheter aortic valve implantation procedures

Transcatheter aortic valve implantation is challenged by the anatomy and calcification of the arteries, aortic arch and aortic valve.

To describe successful complex transcatheter aortic valve implantation with the use of a snare catheter, where other standard techniques have failed.

From the database of 660 transcatheter aortic valve implantation procedures performed at the Clermont-Ferrand University Hospital between 01 February 2023 and 31 August 2024, we report the use of a snare catheter in five complex procedures with transcatheter heart valve advancement failure: two cases of failure to cross the aortic arch with a self-expandable transcatheter heart valve using standard techniques; one case of a horizontal aorta with failed advancement of a self-expandable transcatheter heart valve; a challenging case with significant calcification in the right coronary cusp impeding balloon-expandable transcatheter heart valve progression and crossing the native aortic valve; and another challenging case where the frame of an aortic bioprosthesis prevented the advancement of a self-expandable transcatheter heart valve.

During all these procedures, the use of a snare catheter enabled the challenges of advancement to be overcome, whether within the aortic arch or a horizontal aorta, or when there were difficulties in crossing a native aortic valve or a bioprosthetic aortic valve, thereby allowing the successful implantation of the transcatheter heart valve.

The snare catheter strategy is an effective option for performing complex transcatheter aortic valve implantation procedures, specifically when crossing the aortic arch, a horizontal aorta, the aortic valve or an aortic bioprosthesis, and it is possible to use this technique while using the same access site for self-expandable transcatheter heart valve implantation.