Transcaval access for TAVR across a polyester aortic graft

Catheter Cardiovasc Interv. 2015 Jun;85(7):1270-3. doi: 10.1002/ccd.25781. Epub 2015 Jan 19.

Abstract

Transcaval access to the aorta allows transcatheter aortic valve replacement in patients without other good access options. The resulting aorto-caval fistula is closed with a nitinol cardiac occluder device. There is no experience traversing a synthetic aortic graft to perform transcaval access and closure. We describe a patient who underwent successful traversal of a polyester aortic graft using radiofrequency energy applied from the tip of a guidewire, to allow retrograde transcatheter aortic valve replacement from a femoral vein, along with details of our technique. The patient did well and was discharged home after 3 days. There was residual aorto-caval fistulous flow immediately after implantation of a polyester-seeded nitinol muscular ventricular septal defect occluder device, but this fistula spontaneously occluded within one month.

Keywords: caval-aortic fenestrated graft; extra-anatomic procedures; structural heart disease; transcatheter aortic valve implantation; vascular access and closure.

Publication types

  • Case Reports
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aorta, Abdominal / diagnostic imaging
  • Aorta, Abdominal / surgery*
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / therapy*
  • Aortic Valve* / physiopathology
  • Aortography / methods
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis*
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / methods*
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / methods*
  • Humans
  • Male
  • Polyesters*
  • Prosthesis Design
  • Punctures
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Polyesters