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Step-by-Step ACURATE neo Valve implantation

Case of the month: April 2019

 
This didactic procedure concerns 88 y.o man in good general conditions, presenting Asymptomatic severe Aortic stenosis.
He was successfully treated with transfemoral TAVI using  and implantation of ACURATE neo (Boston Scientific) self-expandable Valve.
 

Educational objectives

  • How to manage parients with severe valvular Aortic stenosis.
  • How to plan & proceed  with TAVI intervention.
  • Tips & Tricks on vascular Access for TAVI.
  • Set Up for Rapid Pacing over the guidewire.
  • When &  How to predilate Aortic Valve before prosthesis implantation.
  • How to make Balloon sizing for predilatation.
  • Different Landmarks & Targets to know during Acurate neo Valve implantation.
  • Step-by-Step Optimal implnatation technique.

Step-by-Step Pocedure

  • Ultrasound Left Common Femoral Artery puncture.
  • Right Common Femoral Artery puncture using Cross-over guidewire as Landmark.
  • Preclosing the right Femoral Arterial Acces with two Proglides.
  • 14F Sheath insertion in the Right Femoral Access.
  • Annulus Sizing & Valve Selection.
  • Pigtail 5F catheter insertion for hemodynamic Monitoring.
  • Valve crossing with JR4 catheter & Floppy 0.035" guidewire.
  • Exchange of the JR catheter to a Pigtail 5F catheter over 0.035 " guidewire.
  • SAFARI (Boston Scientific) 0.038 guidewire insertion over the Pigtail catheter.
  • Working Projection Choice LAO 11° CAU 7°.
  • Setting-up the System for RAPID pacing through the Guidewire.
  • Predilatation with Crista Balloon 18mm (abmedica)  under rapid pacing,aniographic control.
  • Insertion of the Accurate Valve (Boston Scientific).
  • Identifying different Valve components on fluoroscopy.
  • Valve optimal positioning.
  • Step-by-Step valve release.
  • Final Hemodynamic & Angiographic controls.
  • Arterial Access closure.

Biobliography

 



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