Transcatheter Aortic Valve Replacement With Evolut R in a Patient with Severe Degenerative Aortic Regurgitation
- Operator : Duk-Woo Park
|Transcatheter Aortic Valve Replacement With Evolut R in a Patient with Severe Degenerative Aortic Regurgitation|
|- Operators: Duk-Woo Park, MD, Anna Sonio Petronio, MD|
|A 79-year-old male patient was hospitalized for dyspnea, NYHA functional class II-III. He has a past medical history of hypothyroidism, and benign prostatic hyperplasia. There was no significant coronary artery stenosis on the coronary angiogram. Electrocardiography showed normal sinus rhythm. The Society of Thoracic Surgery risk score, EuroSCORE I, and EuroSCORE II were 3.472%, 5.48%, and 1.29%, respectively.|
|Considering the annulus size by CT, we planned to use 26-mm Evolut R valve through left femoral artery. Under general anesthesia, 6 Fr sheath and temporary pacemaker were inserted through left femoral vein, and 7 Fr sheath and 6 Fr pig-tail catheter were inserted through right femoral artery. After both peripheral angiogram with pig-tail catheter, we checked proper puncture site of left femoral artery. 8 Fr sheath was inserted through left femoral artery and preclosure with one Proglide device was done. And then, the left femoral artery was dilated and 18 Fr Sentrant sheath was inserted. An AL 1 diagnostic catheter with a 0.035 inch Amplatz stiff wire was used to cross the aortic valve. Aortic root angiography was done ( Movie 1). And another 6 Fr pig-tail catheter was inserted through the right radial artery and placed on the left coronary cusp to check the axis of annulus plane ( Movie 2). Under fluoroscopy control, the 14 Fr Evolut R delivery catheter system was advanced gently into the vessel. The Evolut R crossed over aortic valve using the super-stiff wire and deployment was done under gradually decreasing ventricular pacing rate from 120 to 90 bpm. After valve implantation, final fluoroscopy showed well positioned Evolut R valve without significant AR. ( Movie 3). After the intervention, puncture site was closed by prepared Proglide device.|
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