Percutaneous aortic valve replacement in patients with challenging aortoiliofemoral access.
Percutaneous aortic valve replacement (PAVR) offers considerable promise in treating high risk patients with aortic valve disease. Two devices are currently clinically available for transfemoral delivery: the Edwards-Sapien balloon-expandable bioprosthesis and the Corevalve self-expanding bioprosthesis, both of which require careful sizing of the peripheral vasculature. Through a case based discussion, we illustrate that these limits of PAVR technology can be stretched in cases of extraordinary clinical need. We demonstrate that, following a learning curve of "optimal cases," successful PAVR is also possible in diffusely diseased peripheries of borderline small size or with focal aortoiliofemoral disease amenable to a separate intervention beforehand.
Jilaihawi
Hasan
H
Glenfield Hospital, Leicester, United Kingdom.
Spyt
Tomasz
T
Chin
Derek
D
Logtens
Elaine
E
Laborde
Jean-Claude
JC
Kovac
Jan
J
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002983:Clinical Competence; D003251:Constriction, Pathologic; D018618:Echocardiography, Doppler, Color; D005260:Female; D005263:Femoral Artery / Q000473:pathology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007083:Iliac Artery / Q000473:pathology; D008297:Male; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D011474:Prosthesis Design; D015641:Radiography, Interventional; D018570:Risk Assessment; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional