Journal of the Society for Cardiovascular Angiography & Interventions · 2023
Novel Lithotripsy-Assisted Transcatheter Aortic Valve Replacement May Reduce Risk of Aortic Root Rupture.
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Seshiah Puvi, Choo Joseph, Garcia Santiago, Kereiakes Dean J
Аннотация
BACKGROUND: 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).
METHODS: 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.
RESULTS: Following IVL, cases 2 and 3 had uncomplicated TAVR with excellent valve frame expansion, and no significant residual gradient or PVL.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: Following IVL, cases 2 and 3 had uncomplicated TAVR with excellent valve frame expansion, and no significant residual gradient or PVL.
CONCLUSIONS: 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.