Cardio-vascular Collaboration is Essential for A 2020 Transcatheter Aortic Valve Replacement (TAVR) Procedures

Trans-catheter aortic valve replacement (TAVR) represents a paradigm shift in therapeutic options for severe symptomatic aortic stenosis. The growth in TAVR demand has further increased with the recent expansion of TAVR into intermediate and lower risk patients. This population is well known to have other cardio-vascular comorbidities-specifically aortic, carotid and peripheral vascular disease (PVD). The femoral artery access is the preferable for TAVR delivery. As such, the typical diffusely calcified artery may cause significant technical difficulties regarding access, delivery, brain protection, and puncture site closure.

To tackle those difficulties, we have established a collaboration between the intervention cardiology and the vascular and endovascular teams. During the last year we have changed the protocol of the pre-op CTA to include a scan from the carotids to the SFA and have recently decided to scan the rest of the lower limbs arteries as well. This change led to a better planning of the access, closure, and brain protection.

We have performed several cases in which Iliac arteries and Aortic bifurcation were treated endovascular in advance or during the TAVR procedure to allow delivery of the valve. In other cases, an open surgical approach was necessary post-TAVR deployment due to failure of closure devices, bleeding or limb ischemia.

In conclusion, we believe this type of collaborative Cardio-Vascular system results in a wider range of medical solutions for these complex patients who suffer from combined “stiff” valves and arteries.