MLSF 2018: Step-by-Step ACURATE neo Valve implantation

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

• 2017 ESC/EACTS Guidelines for the management of valvular heart disease  - Guidelines
  Authors:Helmut Baumgartner  Volkmar Falk  Jeroen J Bax  Michele De Bonis
  Publication:European Heart Journal, Volume 38, Issue 36, 21 September 2017, Pages 2739–2791,
   
• Acurate neo and Evolut PRO in the NEOPRO Registry: Adding Another String to the Bow? - Article
  Authors:Modine T, Overtchouk P.
  Publication:DOI: 10.1016/j.jcin.2018.12.033
   
• Transcatheter Aortic Valve Replacement With Next-Generation Self-Expanding Devices: A Multicenter, Retrospective, Propensity-Matched Comparison of Evolut PRO Versus Acurate neo Transcatheter Heart Valves -Article
  Authors:Pagnesi M, Kim WK, Conradi L, Barbanti M
  Publication:2019 Mar 11;12(5):433-443. doi: 10.1016/j.jcin.2018.11.036.
   
• One-year clinical outcome with a novel self-expanding transcatheter heart valve. - Article
  Authors:Pellegrini C, Rheude T, Trenkwalder T
  Publication:2019 Feb 24. doi: 10.1002/ccd.28144.
   
• Transcatheter aortic valve replacement with new-generation devices: A systematic review and meta-analysis - Article
  Authors:Barbanti M, Buccheri S, Rodés-Cabau J, Gulino S, Généreux P
  Publication: 2017 Oct 15;245:83-89. doi: 10.1016/j.ijcard.2017.07.083. Epub 2017 Jul 25.