TAVI in patients with challenging aortic root anatomy

The aim of study was to investigate the effectiveness of different TAVI techniques and approaches in cases with "horizontal" aorta anatomy

Materials. In our 300 TAVI cases MSCT data were analyzed and in 35 cases (11,7) horizontal aorta was recognized. Certain techniques and access tricks as well as particular manouvers for precise deployment of prosthesis were analyzed as well as type of used valve endoprothesis.

In majority of cases (n-20) self-deploying valve was selected and in 15 cases balloon inflated bioprosthesis was used. Three different types of stiff wires were used for several procedures to introduce the delivery system to aortal position: Amplatz Super Stiff (Boston Scientific), Lunderquist (Cook medical), Amplatz Extra-Stiff (Cook medical).

Transfemoral approach was selected for majority of implantations (18 СoreValve and 10 Edwards). In 4 cases transaxillar approach was performed (both for 2 cases CoreValve and Edwards) and in 3 pts transapical approach was used for Sapien XT valve implantation possibility. In all cases the technical success was reached, but in two CoreValve procedures it was done with second attempt (one case was performed with use of Lunderquist wire and in one case we used Amplatz Super Stiff).

Conclusion. Usage of different practical techniques and access strategies for valve delivery and deployment shall alllow the operator to deal with the challenging horizontal aorta issues and to successfully perform TAVI in majority of cases.