Michael J. Davidson, MD, Frederick G. P. Welt, MD, Andrew C

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Presentation transcript:

Percutaneous Balloon-Expandable Aortic Valve Implantation: Transfemoral Michael J. Davidson, MD, Frederick G.P. Welt, MD, Andrew C. Eisenhauer, MD Operative Techniques in Thoracic and Cardiovascular Surgery Volume 16, Issue 1, Pages 30-40 (March 2011) DOI: 10.1053/j.optechstcvs.2010.12.005 Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 1 Post-deployment view of Sapien THV (transcatheter heart valve) in position at the native annulus, with the native aortic valve leaflets displaced into the sinuses of valsalva. a. = artery; THV = transcatheter heart valve. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 30-40DOI: (10.1053/j.optechstcvs.2010.12.005) Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 2 Localizing the optimal site for femoral arterial access. (A) Anatomy of the femoral vessels at the inguinal ligament. Note location of arterial puncture at common femoral artery, above the bifurcation of the artery and below the inguinal ligament. (B) Femoral angiogram through a micropuncture dilator demonstrating appropriate femoral artery access site. a. = artery; lig. = ligament. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 30-40DOI: (10.1053/j.optechstcvs.2010.12.005) Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 3 Use of the 10 French Perclose Prostar (Abbott Laboratories, Abbott Park, IL) used to “preclose” the access in the femoral artery. (A) Demonstrates the device in the artery, with (B) showing the sutures after deployment. Note that use of this device for preclosure of large-bore access is off-label in the United States. a. = artery. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 30-40DOI: (10.1053/j.optechstcvs.2010.12.005) Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 4 Strategy for managing femoral access percutaneously. (A) A sheath crossing over from the left common femoral artery to the left iliofemoral system. (B) The sheath pulled back to the descending aorta with its 0.018-inch guidewire maintained in the contralateral femoral artery and a 0.035-inch guidewire going to the aortic arch, over which a pigtail catheter will be placed. (C) The Sapien delivery sheath placed from the left common femoral artery, alongside the previously placed 0.018-inch guidewire. (D) The Sapien delivery sheath being pulled back, with the contralateral sheath used to deliver a proximal compliant balloon to the iliac artery above the sheath. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 30-40DOI: (10.1053/j.optechstcvs.2010.12.005) Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 5 (A) A balloon aortic valvuloplasty performed using retrograde arterial access. (B) The Sapien valve being maneuvered along the aortic arch over the guidewire toward the aortic valve. (C) The Sapien valve positioned in the native aortic annulus. (D) Balloon inflation, deploying the prosthetic valve in the native aortic annulus. (E) The Sapien valve after deployment. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 30-40DOI: (10.1053/j.optechstcvs.2010.12.005) Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 5 (A) A balloon aortic valvuloplasty performed using retrograde arterial access. (B) The Sapien valve being maneuvered along the aortic arch over the guidewire toward the aortic valve. (C) The Sapien valve positioned in the native aortic annulus. (D) Balloon inflation, deploying the prosthetic valve in the native aortic annulus. (E) The Sapien valve after deployment. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 30-40DOI: (10.1053/j.optechstcvs.2010.12.005) Copyright © 2011 Elsevier Inc. Terms and Conditions