Transcatheter Aortic Valve Implantation

Cardiac Sciences | Posted on 01/18/2023 by RBH

Mr Tirath Das Nankanki contacted Rukmani Birla Hospital with issues involving shortness of breath. Upon comprehensive evaluation and test results, Mr Nankanki was diagnosed with HTN, Severe AS, CAD – ACS, IHD – Double vessel disease (CAG Outside). The doctor recommended Right Trans-femoral TAVI using 32mm MyVal. 

Procedure:

The procedure was done under conscious sedation. After prep and drape, a micropuncture kit was used to gain access to the left common femoral artery & vein 7F sheath was placed. A 5F Balloon tip temporary pacing catheter was placed at RV Apex along with a 6F angled pigtail catheter positioned in NCC. A micropuncture kit was used to obtain access to the right common femoral artery to perform a femoral angiogram. Subsequently, a one 6F per close ProGlide Suture-Mediated Closure System was placed. 

Then, a 0.035” x 260 cm lunderquist wire is installed in place of the regular 0.035 wire and the access site was serially dilated. Subsequently, a 14F Python Sheath was finally placed in the right common femoral artery over a stiff wire and an IV Heparin was administered in accordance with an ACT of 300. 6F angled pigtail catheter was advanced into NCC. The aortic valve was crossed using a 5F AL1 catheter and straight-tip terumo stiff wire. Hemodynamic measurements were performed. Safari Extra Small curve was then positioned at LV apex and a 32 mm Myval (Meril Lifesciences) was deployed at the aortic position under rapid pacing. 

The final angiogram showed promising results. The 14F Sheath was removed and 8F per close was deployed. The pelvic angiogram showed good hemostasis. The surgeon then removed the balloon-tipped temporary pacemaker and the left common femoral artery is closed with Angio Seal. The left common femoral vein sheath was removed and manual pressure was applied. Finally, the patient was shifted to the intensive care unit in stable condition. The result of the Transcatheter Aortic Valve Implantation was a successful one.