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Under-deployed TAVI with occluded left-main and severe aortic regurgitation; bailout chimney-in-chimney stenting and aggressive postdilatation saves the day.

ABSTRACT: Narrow calcific aortic roots with low coronary heights present challenges for a successful trans-catheter aortic valve replacement. We describe a case where pre-emptive coronary protection and chimney stent-in-stent procedure was successfully performed during a cardiac arrest secondary to coronary occlusion and restricted TAVI valve deployment in such an anatomy.

SUBMITTER: Athauda-Arachchi P

PROVIDER: S-EPMC9361718 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Under-deployed TAVI with occluded left-main and severe aortic regurgitation; bailout chimney-in-chimney stenting and aggressive postdilatation saves the day.

Athauda-Arachchi Pandula P

Clinical case reports 20220809 8

Narrow calcific aortic roots with low coronary heights present challenges for a successful trans-catheter aortic valve replacement. We describe a case where pre-emptive coronary protection and chimney stent-in-stent procedure was successfully performed during a cardiac arrest secondary to coronary occlusion and restricted TAVI valve deployment in such an anatomy. ...[more]

PMID: 35957777

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Project description:AimTranscatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic stenosis in patients with intermediate to prohibitive surgical risk. When a single TAVI device fails and cannot be retrieved, TAVI-in-TAVI must be performed acutely, but outcomes of bailout TAVI-in-TAVI have been incompletely appraised. We aimed at analyzing patient, procedural and outcome features of patients undergoing bailout TAVI-in-TAVI in a multicenter registry.MethodsDetails of patients undergoing bailout TAVI-in-TAVI, performed acutely or within 24 h of index TAVI, in 6 international high-volume institutions, were collected. For every case provided, 2 same-week consecutive controls (prior TAVI, and subsequent TAVI) were provided. Outcomes of interest were procedural and long-term events, including death, myocardial infarction, stroke, access site complication, major bleeding, and reintervention, and their composite (i.e. major adverse events [MAE]).ResultsA total of 106 patients undergoing bailout TAVI-in-TAVI were included, as well as 212 controls, for a total of 318 individuals. Bailout TAVI-in-TAVI was less common in younger patients, those with higher body mass index, or treated with Portico/Navitor or Sapien devices (all p < 0.05). Bailout TAVI-in-TAVI was associated with higher in-hospital rates of death, emergency surgery, MAE, and permanent pacemaker implantation (all p < 0.05). Long-term follow-up showed that bailout TAVI-in-TAVI was associated with higher rates of death and MAE (both < 0.05). Similar findings were obtained at adjusted analyses (all p < 0.05). However, censoring early events, outlook was not significantly different when comparing the two groups (p = 0.897 for death, and p = 0.645 for MAE).ConclusionsBail-out TAVI-in-TAVI is associated with significant early and long-term mortality and morbidity. Thus, meticulous preprocedural planning and sophisticated intraprocedural techniques are of paramount importance to avoid these emergency procedures.

Dataset Information

Under-deployed TAVI with occluded left-main and severe aortic regurgitation; bailout chimney-in-chimney stenting and aggressive postdilatation saves the day.

Publications

Under-deployed TAVI with occluded left-main and severe aortic regurgitation; bailout chimney-in-chimney stenting and aggressive postdilatation saves the day.

Similar Datasets

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