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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Two-Staged Transcatheter Aortic Valve Replacement in Severely Calcified Sinotubular Junction
Shivani Bhat1, Chase J Ellingson2, Jyotpal Singh3
1Prairie Vascular Research Inc, Regina, Canada; College of Medicine, University of Saskatchewan, Regina, Canada; Saskatchewan Health Authority (SHA), Saskatoon, Canada.
Objective:
Severe sinotubular junction (STJ) calcification presents important challenges during transcatheter aortic valve implantation, including risk of aortic dissection or aortic root rupture and valve malposition. We describe a straightforward and reproducible two-stage balloon inflation technique with a balloon-expandable SAPIEN 3 valve to optimize precision and procedural safety in this difficult setting.
Technique:
Step 1: Initial balloon inflation at 2 mL less than nominal volume to secure annular anchoring and limit radial force on the calcified STJ. Step 2: Balloon advanced 1-2 mm under fluoroscopy toward the inflow and inflated to the full nominal volume, completing valve deployment.
Pitfalls:
Inadequate anchoring may cause migration or embolization, underestimation of calcification can compromise expansion, and balloon overinflation may cause root injury.
Conclusion:
This staged inflation method anchors the valve, minimizes STJ stress, and provides a simple, reproducible strategy that may improve safety in anatomically complex patients.
