A safe and simple technique for crossing stenotic aortic valves
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ORIGINAL PAPER
A safe and simple technique for crossing stenotic aortic valves Wolfgang Schoels1 · Marwan S. Mahmoud2 · Mathias Kullmer1 · Mohamad Dia3 Received: 7 July 2020 / Accepted: 5 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives To describe and to validate a new technique for crossing stenotic aortic valves (AV). Background Current techniques for crossing the AV may be time-consuming and hazardous. Methods One hundred consecutive patients with severe aortic stenosis treated by transfemoral TAVI were prospectively selected to have an initial attempt of 5 min to cross the AV with a novel pigtail/J-wire technique before switching to the conventional Amplatz®/straight wire approach. For the pigtail/J-wire technique, the catheter is placed 3–4 cm above the AV and turned anteriorly in the 30° RAO view. A J-wire pushed out of the pigtail-catheter will reach the anterior wall of the ascending aorta, forming a u-shaped curve above the AV. The height of the pigtail catheter determines the width of the curve, rotation will help to find an orientation, where the vertex of the curved J-wire easily passes the AV. We analyzed the primary success rate within 5 min and the mean crossing time required. Results Patients were 83.5 ± 5.5 years of age and predominantly male (62%). Primary success rate was 86%, AV crossing took 48.2 ± 34.6 s without complications. Fourteen failed cases were successfully managed with AL1- (6) and both, AL1and AL2-catheters (8), respectively Conclusions The pigtail/J-wire technique for AV crossing is safe, simple and fast. Primary placement of a pigtail catheter into the left ventricle at a success rate of 86% facilitates TAVI procedures. Keywords Transcatheter aortic valve implantation (TAVI) · Aortic stenosis · Valve crossing Abbreviations AV Aortic valve TAVI Transcatheter aortic valve implantation AL Amplatz left RAO Right anterior oblique PCI Percutaneous coronary intervention STS Society of thoracic surgery score
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00392-020-01744-4) contains supplementary material, which is available to authorized users. * Wolfgang Schoels [email protected] 1
Department of Cardiology, Duisburg Heart Center, Gerrickstrasse 21, 47137 Duisburg, Germany
2
Department of Cardiology, Assiut University Heart Hospital, Assiut University, Assiut, Asyut, Arab Republic of Egypt
3
Department of Cardiac Surgery, Duisburg Heart Center, Duisburg, Germany
Introduction Over the last decade, transcatheter aortic valve implantation (TAVI) has evolved as the treatment of choice for the majority of elderly patients with symptomatic severe aortic stenosis [1]. Retrograde crossing of the aortic valve (AV) is an essential step not only during TAVI procedures [2], but also during diagnostic procedures in uncertain cases. Commonly, a left A mplatz® catheter (Boston Scientific, Marlborough, MA, USA) and a soft straight-tip wire are used to cross the AV
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