title: TAVR Through Heavily Calcified Aorta Following Atheroma Retrieval With the "Elevator" Technique.
abstract: An 86-year-old Caucasian female with severe symptomatic, inoperable aortic stenosis was accepted for high-risk transfemoral transcatheter aortic valve replacement (TAVR) approach due to severe calcification of the aorta. During initial passage of a 22 Fr sheath, there was dislodgment with proximal migration of a circumferential tunnel of calcium from the infrarenal aorta. A novel "elevator" technique was used to secure and retrieve the dislodged aorta en bloc back to its original infrarenal aortic position and allow in situ fixation with stenting. A new TAVR system was then successfully placed through the stent and a 23 mm Edwards Sapien valve (Edwards Lifesciences) was implanted as planned. In case of calcification protruding into the lumen of the aorta and limiting the passage of the large valve delivery system sheath, the obstruction can be managed by stenting the calcification against the luminal wall under fluoroscopic and intravascular-ultrasound guidance, allowing successful passage of the valve delivery system. The elevator technique allows axial transportation of any calcified vascular fragments, should they become dislodged.
authors.forename: N Boopathy
authors.initials: NB
authors.lastname: Senguttuvan
authors.forename: Sharif
authors.initials: S
authors.lastname: Ellozy
authors.forename: Furqan
authors.initials: F
authors.lastname: Tejani
authors.forename: Jason
authors.initials: J
authors.lastname: Kovacic
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
authors.affiliation: Mount Sinai Medical Center, New York, NY 10029 USA. George.Dangas@MountSinai.org.
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
mesh_terms: D000369:Aged, 80 and over; D000792:Angiography; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017073:Atherectomy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011474:Prosthesis Design; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D018084:Ultrasonography, Interventional