title: Transcaval access for TAVR across a polyester aortic graft.
abstract: Transcaval access to the aorta allows transcatheter aortic valve replacement in patients without other good access options. The resulting aorto-caval fistula is closed with a nitinol cardiac occluder device. There is no experience traversing a synthetic aortic graft to perform transcaval access and closure. We describe a patient who underwent successful traversal of a polyester aortic graft using radiofrequency energy applied from the tip of a guidewire, to allow retrograde transcatheter aortic valve replacement from a femoral vein, along with details of our technique. The patient did well and was discharged home after 3 days. There was residual aorto-caval fistulous flow immediately after implantation of a polyester-seeded nitinol muscular ventricular septal defect occluder device, but this fistula spontaneously occluded within one month.
authors.affiliation: Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lederman
authors.affiliation: Division of Cardiology, Henry Ford Health System, Institute for Structural Heart Disease, Detroit, Michigan.
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
authors.affiliation: Division of Cardiology, Henry Ford Health System, Institute for Structural Heart Disease, Detroit, Michigan.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Greenbaum
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D011091:Polyesters; D011474:Prosthesis Design; D011677:Punctures; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D011091:Polyesters
keywords: caval-aortic fenestrated graft; extra-anatomic procedures; structural heart disease; transcatheter aortic valve implantation; vascular access and closure