Dataset Information

Navigating premature rupture of the expandable sheath delivery system during elective transfemoral transcatheter aortic valve implantation: a case report.

ABSTRACT:

Background

Transcatheter aortic valve implantation (TAVI) has revolutionised the treatment of severe aortic stenosis, but is still associated with a risk of major vascular complication.

Case summary

An elective transfemoral TAVI was undertaken for severe aortic stenosis. During delivery of a 26mm Sapien S3 valve, the delivery system sheath (eSheath) split prematurely. The valve could not be advanced, and lay parallel to the sheath body. Following advice, an attempt was made to remove the system en bloc but this was unsuccessful. After careful consideration of alternative options, the valve was advanced with reasonable force and the case was completed successfully. The femoral artery was closed with parclose sutures without major vascular complication.

Discussion

Early recognition of a split sheath with effective communication between lab team members and the manufacturer allowed us to successfully navigate this case, with a good outcome for our patient.

SUBMITTER: Chapman AR

PROVIDER: S-EPMC10236206 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

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Publications

Navigating premature rupture of the expandable sheath delivery system during elective transfemoral transcatheter aortic valve implantation: a case report.

Chapman Andrew R AR Russell-Dalton Anastasia A Holland James J Flapan Andrew D AD

European heart journal. Case reports 20230509 6

<h4>Background</h4>Transcatheter aortic valve implantation (TAVI) has revolutionised the treatment of severe aortic stenosis, but is still associated with a risk of major vascular complication.<h4>Case summary</h4>An elective transfemoral TAVI was undertaken for severe aortic stenosis. During delivery of a 26mm Sapien S3 valve, the delivery system sheath (eSheath) split prematurely. The valve could not be advanced, and lay parallel to the sheath body. Following advice, an attempt was made to rem ...[more]

PMID: 37275435

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Project description:BackgroundDiabetes Mellitus (DM) affects a third of patients with symptomatic severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). DM is a well-known risk factor for cardiac surgery, but its prognostic impact in TAVI patients remains controversial. This study aimed to evaluate outcomes in diabetic patients undergoing TAVI.MethodsThis multicentre registry includes data of > 12,000 patients undergoing transfemoral TAVI. We assessed baseline patient characteristics and clinical outcomes in patients with DM and without DM. Clinical outcomes were defined by the second valve academic research consortium. Propensity score matching was applied to minimize potential confounding.ResultsOf the 11,440 patients included, 31% (n = 3550) had DM and 69% (n = 7890) did not have DM. Diabetic patients were younger but had an overall worse cardiovascular risk profile than non-diabetic patients. All-cause mortality rates were comparable at 30 days (4.5% vs. 4.9%, RR 0.9, 95%CI 0.8-1.1, p = 0.43) and at one year (17.5% vs. 17.4%, RR 1.0, 95%CI 0.9-1.1, p = 0.86) in the unmatched population. Propensity score matching obtained 3281 patient-pairs. Also in the matched population, mortality rates were comparable at 30 days (4.7% vs. 4.3%, RR 1.1, 95%CI 0.9-1.4, p = 0.38) and one year (17.3% vs. 16.2%, RR 1.1, 95%CI 0.9-1.2, p = 0.37). Other clinical outcomes including stroke, major bleeding, myocardial infarction and permanent pacemaker implantation, were comparable between patients with DM and without DM. Insulin treated diabetics (n = 314) showed a trend to higher mortality compared with non-insulin treated diabetics (n = 701, Hazard Ratio 1.5, 95%CI 0.9-2.3, p = 0.08). EuroSCORE II was the most accurate risk score and underestimated 30-day mortality with an observed-expected ratio of 1.15 in DM patients, STS-PROM overestimated actual mortality with a ratio of 0.77 and Logistic EuroSCORE with 0.35.ConclusionDM was not associated with mortality during the first year after TAVI. DM patients undergoing TAVI had low rates of mortality and other adverse clinical outcomes, comparable to non-DM TAVI patients. Our results underscore the safety of TAVI treatment in DM patients.Trial registrationThe study is registered at clinicaltrials.gov (NCT03588247).

Dataset Information

Navigating premature rupture of the expandable sheath delivery system during elective transfemoral transcatheter aortic valve implantation: a case report.

Background

Case summary

Discussion

Publications

Navigating premature rupture of the expandable sheath delivery system during elective transfemoral transcatheter aortic valve implantation: a case report.

Similar Datasets

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