title: Transfemoral implantation of an Edwards SAPIEN valve in a tricuspid bioprosthesis without fluoroscopic landmarks.
abstract: OBJECTIVE
  We describe the first report of an Edwards SAPIEN valve implanted in a tricuspid bioprosthesis from the femoral vein. We highlight the feasibility of this previously avoided approach and the techniques involved.
  
  
  RESULTS
  A 61-year-old woman with multiple valve replacements for rheumatic heart disease presented with NHYA IV dyspnoea secondary to a severely stenosed tricuspid bioprosthesis. After failed aggressive medical therapy and surgical turn down, an Edwards SAPIEN XT valve was deployed in the tricuspid bioprosthesis via the right femoral vein. Adaptations to the standard transfemoral transcatheter aortic valve implantation (TAVI) technique included: (1) crossing the tricuspid bioprosthesis with a balloon floatation catheter; (2) temporary pacing wire in the coronary sinus rather than the right ventricle; (3) mounting of the SAPIEN XT valve in the reverse orientation to transfemoral TAVI; and (4) fine positioning of the final valve position pre-deployment by 3D transoesophageal echocardiography (3D TOE) alone due to complete radiolucency of the tricuspid bioprosthesis. The procedure was completed without complication and resulted in significant symptomatic improvement.
  
  
  CONCLUSIONS
  Deployment of an Edwards SAPIEN valve in a tricuspid bioprosthesis via the femoral vein is feasible and, with careful adaptations to established TAVI techniques, can be performed without complications and with good clinical response.
authors.affiliation: Centre Hospitalier Universitaire Bichat, Paris, France. paddy@doctors.org.uk
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Calvert
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.forename: Costin
authors.initials: C
authors.lastname: Radu
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Ulrik
authors.initials: U
authors.lastname: Hvass
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Darondel
authors.forename: Jean-Pol
authors.initials: JP
authors.lastname: Depoix
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
mesh_terms: D059925:Anatomic Landmarks; D001705:Bioprosthesis; D019560:Echocardiography, Three-Dimensional; D005260:Female; D005263:Femoral Artery; D005471:Fluoroscopy; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D014264:Tricuspid Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*