Novel EBU Catheter-Assisted Parallel Wire Technique for Difficult Aortic Valve Crossing (EUPASS)

Difficult retrograde crossing of a severely stenotic aortic valve remains a key technical limitation during transcatheter aortic valve interventions. We describe a novel EBU catheter-assisted parallel wire technique for retrograde aortic valve crossing (EUPASS) that enables 3-dimensional coaxial alignment and controlled guidewire advancement across the valve. EUPASS was applied as a bailout (n = 16) or primary (n = 7) strategy in 23 of 164 patients with severe aortic stenosis and complex anatomy, including frequent bicuspid valves (8 in 23, or 34.8%) and horizontal aortic angulation (16 in 23, or 69.6%). Using a single guiding catheter and parallel straight and looped guidewires, valve crossing and left ventricular apical wire positioning were achieved in all cases, typically within 2 minutes, without procedural complications. The technique provided a stable rail for seamless continuation of balloon valvuloplasty or transcatheter aortic valve replacement. EUPASS represents a simple and reproducible technical solution for challenging retrograde aortic valve crossing.