ars Sondergaard - Consultant Cardi ajesh Nair - Consultant Cardiologist, Wa ologist, Rigshospitalet, Denmark

Transcription

1 TAVI for bio-prost hetic aortic valve insufficiency ars Sondergaard - Consultant Cardi ajesh Nair - Consultant Cardiologist, Wa ologist, Rigshospitalet, Denmark aikato Hospital, New Zealand

2 Dr Lars Sondergaard d - Proctor for CoreValve. Dr Rajesh Nair - No confl ict of interests to declare.

3 ial force - orients the system, the stent-frame to the aortic wall. nnular valve prosthesis within the const trained of the stent frame; avoids coronary arteries supra leaflet function. ial force - the the expansile stent-framee secures g of the device at the annular plane. The skirt minimizes paraprosthetic aortic ation.

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5 of inflow portion of device _ w bioprosthetic aortic annulus implant mm) y supra-annular Optimal implant (depth = 8.4 mm) valve supra-annular Deep implant (depth = 12.7 mm) valve annular Very deep im (depth = 18.4 valve infra-a

6 oles are designed to preserve y flow if the Medtronic-Corevalve is y placed.

7 ear old male, Jehovas witness. G + AVR (aortic stenosis, 27 mm Toronto valve SPV) urrent admissions with pulmonary oedema. iscence of valve leaflet causing severe aortic insufficiency. ent coronary grafts. QuickTime?and a decompressor

8 ultidisciplinary team meeting favoured transcatheter aortic valve implant orevalve

9 St Jude Toronto SPV

10 Sub coronary implant

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12 QuickTime?and a 24.3 mm izontal aorta. ntless Toronto bio-prosthetic ti root & valv e. rse calcium along aortic annulus; meas sured 24.3 mm on TEE.

13 ventricular outflow tract. Plan to deploy under rapid pacing. QuickTime?and a Pulseless l electrical l activity it during phase of release. QuickTime?and a orevalve sits too deep, causing severe sthetic leak.

14 nt transferred to ICU, difficult extubation after 24 hours. ctory pulmonary oedema. nt again refuses transfusion of blood products or any surgical treatment. formed consent for percutaneous repos sition of CoreValve.

15 QuickTime?and a QuickTime?and a

16 er super stiff wire passed via the stent struts of distal CoreValve from left f nd a high pressure balloon (Tyshaq 3*20 cm) inflated on the outer side lve. QuickTime?and a are needed to seee this picture.

17 Partial collapse of deflated balloon an st tuck behind the valve stent struts. QuickTime?and a QuickTime?and a nt forceful traction over a period of 30 - severe deformation of distal CoreValv ve.

18 Core evalve is inflated flush with the ab aortaa using high torque balloon. QuickTime?and a QuickTime?and a etal CP stent deployed inside the

19 Further traction of second and the most p valves in the aortic root to obtain optimal po QuickTime?and a Pat tient t recovered over next 4 weeks in h with intact neurological, cardiovascular an func ction. up in 14 months, mobile and functional ve in position.

20 Q i kti? QuickTime?and a H.264 decompressor

21 VI should be done with extreme caution in patients with isolated AR - propensi bolise. revalve should be positioned under rapid pacing in patients with severe rticularly when there is sparse annular calcification. revalve is repositionable - firm sustained traction by snaring the distal islet o revalve along the lesser curvature of aorta is recommended. apping balloons behind the stent struts of CoreValve for repositioning empted as a last resort and is NOT reco ommended.