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Description
Shooting date : 2019-02-04
Last update : 2020-03-04
Language(s) : English
 
Patient data
  • 70 year-old female
  • Previous surgery : Aortic dissection in 2005 (supra coronary replacement with a tube of 30mm)
  • NYHA III Dyspnea with 3 episodes of acute pulmonary oedema
  • TTE: LEF 60%, severe AI with cusp prolaps, LV dilatation and secondary MI grade II and TI grade II
  • Left heart cath: Normal
  • EuroSCORE I 20,6%; II 6,19%, high risk surgery
  • Heart TEAM: off- label TAVR followed by Mitraclip in a second step if needed
Description of procedure
  • Main arterial acces: Left commun carotid (the only non dissected artery)
  • Pigtail from the right arterial artery
  • Aortic surface 3,4cm² and perimeter 6,7cm
  • Corevalve Pro 26mm with deployement on rapid pacing and TEE guidance
Strategy & approach
  • Discussion in Heart Team and patient jugged at high risk for redo surgery. Endovascular treatment of aortic insufficiency
Devices used
  • Corevalve Pro 26mm
Medical therapy
  • Not applied in this case

Operators:

  • Surgeons: Dr Fabre, Dr Hysi
  • Cardiologist: Dr Pécheux, Dr Hannebicque
  • Anesthesiologist: Dr Rebet
 
Bibliography
  1. Roy DA, Schaefer U, Guetta V, Hildick-Smith D, Möllmann H, Dumonteil N, et al. Transcatheter aortic valve implantation for pure severe native aortic valve regurgitation. J Am Coll Cardiol 2013;61:1577–84.
  2. Abdelaziz HK, Wiper A, More RS, Bittar MN, Roberts DH. Successful Transcatheter Aortic Valve Replacement Using Balloon-Expandable Valve for Pure Native Aortic Valve Regurgitation in the Presence of Ascending Aortic Dissection. J Invasive Cardiol 2018;30:E62–E63.
  3. Caporali E, Pedrazzini G, Demertzis S, Ferrari E. Transcatheter aortic valve implantation for recurrent Valsalva sinus re-dissection and severe aortic regurgitation shortly after surgery for type-A aortic dissection. Interact Cardiovasc Thorac Surg 2017;25:839–41.
  4. Maureira P, Liu Y, Stafford N, Fiore A, Angioi M. Transcatheter aortic valve implantation via right carotid artery route for severe aortic regurgitation management in a patient with chronic operated type A aortic dissection. Heart Surg Forum 2014;17:E242–244.
  5. Bruschi G, Colombo P, Nava S, Musca F, Merlanti B, Belli O, et al. Evolut R Implantation to Treat Severe Pure Aortic Regurgitation in a Patient With Mitral Bioprosthesis. Ann Thorac Surg 2016;102:e521–e524.
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