4-Dimensional Intracardiac Echocardiography-Guided Antegrade TAVR Using a Novel CABLE-TAVR Technique

An antegrade approach to transcatheter aortic valve replacement (TAVR) has become less common because of the complexity and chance of complication, but use of a large-bore sheath to protect the mitral valve has been described.

We present a 75-year-old patient with severe symptomatic aortic stenosis who underwent antegrade TAVR with 4-dimensional intracardiac echocardiography under conscious sedation. We describe a novel technique using an Edwards Commander Delivery System to flex a large-bore sheath across the mitral valve to protect the atrial septum and mitral valve during valve delivery.

Patients with limited vascular access for retrograde TAVR and who are not candidates for general anesthesia owing to pulmonary disease can undergo antegrade TAVR under conscious sedation and 4-dimensional intracardiac echocardiography guidance.

Our case illustrates an antegrade approach with a novel technique that may be a suitable alternative to TAVR in high-risk patients who otherwise would not be candidates for aortic valve replacement.