Combined Transcatheter Aortic Valve Replacement and Thoracic Endovascular Aortic Repair Using Transapical Access Keith B. Allen, MD, Lesley M. Johnson,

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Presentation transcript:

Combined Transcatheter Aortic Valve Replacement and Thoracic Endovascular Aortic Repair Using Transapical Access Keith B. Allen, MD, Lesley M. Johnson, BA, A. Michael Borkon, MD, Sanjeev Aggarwal, MD, J. Russell Davis, MD, David J. Cohen, MD, Adnan K. Chhatriwalla, MD, Aaron Grantham, MD, Anthony Hart, MD The Annals of Thoracic Surgery Volume 100, Issue 2, Pages 723-727 (August 2015) DOI: 10.1016/j.athoracsur.2014.10.024 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Computed tomography shows a symptomatic 9-cm thoracic aortic aneurysm. The Annals of Thoracic Surgery 2015 100, 723-727DOI: (10.1016/j.athoracsur.2014.10.024) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The initial transfemoral angiogram demonstrates a large aneurysm with an adequate proximal landing area in zone 2, with planned left subclavian artery coverage. The Annals of Thoracic Surgery 2015 100, 723-727DOI: (10.1016/j.athoracsur.2014.10.024) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) The left ventricular apex was exposed using a limited left anterolateral thoracotomy and a soft tissue retractor with minimal rib distraction. (B) The left ventricular (LV) apex was accessed, and a stiff wire was placed across the aortic valve to insert the 22F delivery sheath. (C) The distal thoracic endograft was deployed, and the proximal endograft was positioned for a zone 2 landing, with coverage of the left subclavian artery. The Annals of Thoracic Surgery 2015 100, 723-727DOI: (10.1016/j.athoracsur.2014.10.024) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) An intraoperative completion angiogram shows good graft position in zone 2, a patent left common carotid artery, and coverage of the left subclavian artery, without endoleak. (B) Computed tomography at 1 year demonstrates a collateralized left subclavian artery and no endoleak. The Annals of Thoracic Surgery 2015 100, 723-727DOI: (10.1016/j.athoracsur.2014.10.024) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A) A computed tomography angiogram shows an 8-cm thoracic aortic aneurysm with surrounding hematoma. (B) Sagittal three-dimensional reconstruction demonstrates aortic deformity and the entry site of the previous type B dissection. The Annals of Thoracic Surgery 2015 100, 723-727DOI: (10.1016/j.athoracsur.2014.10.024) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Abdominal computed tomography shows (A) the previous superior mesenteric artery stent (arrow) protruding significantly into the aorta lumen, (B) making questionable safe passage and withdrawal of large endovascular devices during transfemoral transcatheter aortic valve replacement/thoracic aortic endovascular repair (arrow). The Annals of Thoracic Surgery 2015 100, 723-727DOI: (10.1016/j.athoracsur.2014.10.024) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Computed tomography at the 6-month follow-up shows the skirt of the percutaneous valve and the endograft in excellent position, without an endoleak. The Annals of Thoracic Surgery 2015 100, 723-727DOI: (10.1016/j.athoracsur.2014.10.024) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions