Balloon-assisted crossing via trans-radial access during transcatheter aortic valve implantation: a case series demonstrating the BACTRA technique.

BACKGROUND

Crossing the aortic valve with the device during transcatheter aortic valve implantation (TAVI) can be challenging, with several troubleshooting techniques described. Balloon-assisted valve crossing is commonly considered, although the need for a second femoral access of sufficient size to accommodate the valvuloplasty balloon limits its appeal.

CASE SUMMARY: In this two-case series, we demonstrate the feasibility of balloon-assisted aortic valve crossing for both balloon-expandable and self-expanding TAVI platforms using percutaneous transluminal peripheral angioplasty balloons delivered via trans-radial access. Where difficulty was encountered with crossing the valve and basic techniques were unsuccessful, the BACTRA (Balloon-Assisted Crossing via Trans-Radial Access) technique facilitated valve crossing and successful valve deployment. In Case 1, the inability to cross the valve related predominantly to severe tortuosity throughout the arterial tree and a subsequent lack of torque and device manipulation to negotiate the native valve. In Case 2, the issue largely related to the horizontal aorta. Both patients had successful valve deployment and were subsequently discharged well.

DISCUSSION: Regardless of the underlying cause or the TAVI platform utilized, this report demonstrates that the BACTRA technique has several plausible benefits. Valve crossing was facilitated in both cases without additional arterial punctures or sheath upsizing, allowing the procedures to proceed efficiently and safely without any added risk of vascular complications. Procedural steps, troubleshooting, and equipment compatibility are outlined in this case series.