title: First use of an expandable sheath and transcaval access for transcatheter Edwards SAPIEN 3 aortic valve implantation.
abstract: OBJECTIVE
  We aimed to describe the first percutaneous transcaval TAVI in Europe using the expandable introducer sheath (eSheath; Edwards Lifesciences, Irvine, CA, USA) for implantation of an Edwards SAPIEN 3 aortic valve (23 mm).
  
  
  RESULTS
  A 72-year-old male patient presented with dyspnoea (NYHA III) in part due to severe aortic stenosis. Concomitant diseases were severe peripheral artery disease, severe chronic obstructive pulmonary disease (GOLD IV) and renal insufficiency, such that neither a transfemoral nor a transapical approach was considered favourable. An eSheath was introduced into the abdominal aorta via the femoral vein and the inferior vena cava. TAVI was then performed according to standard procedures. After TAVI, the veno-arterial junction was occluded with a 6 mm AMPLATZER Muscular VSD Occluder (St. Jude Medical, St. Paul, MN, USA) using an 8.5 Fr Agilis™ sheath (St. Jude Medical) inside the TAVI sheath. Aortography showed no retroperitoneal accumulation of contrast media. The femoral vein access site was closed using two prepositioned sutures (ProGlide; Abbott Vascular, Santa Clara, CA, USA). A CT scan the following day showed no retroperitoneal haemorrhage.
  
  
  CONCLUSIONS
  Percutaneous transcaval venous access to the aorta may provide a new access strategy for TAVI in otherwise ineligible patients and appears safe with expandable sheath technology.
authors.affiliation: Deutsches Herzzentrum München und Technische Universität München, Munich, Germany.
authors.forename: Ilka
authors.initials: I
authors.lastname: Ott
authors.forename: Adam B
authors.initials: AB
authors.lastname: Greenbaum
authors.forename: Heribert
authors.initials: H
authors.lastname: Schunkert
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
authors.forename: Markus
authors.initials: M
authors.lastname: Kasel
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001027:Aortography / Q000379:methods; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods; D062906:Cardiac Catheters; D004867:Equipment Design; D005268:Femoral Vein; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D010690:Phlebography / Q000379:methods; D011677:Punctures; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging