Algorithm for systematic valve-crossing in transcatheter aortic valve implantation

Mi Chen; Jonathan Michel; Barbara E Stähli; Christian Templin; Philipp Jakob; Felix C Tanner; Albert Markus Kasel

doi:10.1093/ejcts/ezac396

Algorithm for systematic valve-crossing in transcatheter aortic valve implantation

Eur J Cardiothorac Surg. 2022 Aug 3;62(3):ezac396. doi: 10.1093/ejcts/ezac396.

Authors

Mi Chen^{1

2}, Jonathan Michel¹, Barbara E Stähli¹, Christian Templin¹, Philipp Jakob¹, Felix C Tanner¹, Albert Markus Kasel¹

Affiliations

¹ University Heart Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
² Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

PMID: 35920768
DOI: 10.1093/ejcts/ezac396

Abstract

The retrograde valve-crossing of a stenotic aortic valve is a crucial step in the transcatheter aortic valve implantation procedure. In addition to being time-consuming and associated with an increased stroke risk, inappropriate valve-crossing may cause devastating complications. This tutorial review summarizes systematic and detailed techniques to cross the aortic valve. First, the main challenges in retrograde valve-crossing are depicted. Next, a step-by-step guidance on valve-crossing is provided, along with an in-depth description of the three-dimensional anatomy under a two-dimensional fluoroscopy view. Finally, modified techniques for different anatomies are described.

Keywords: Aortic stenosis; Transcatheter aortic valve implantation; Transcatheter heart valve; Valve-crossing.

MeSH terms

Algorithms
Aortic Valve / diagnostic imaging
Aortic Valve / surgery
Aortic Valve Stenosis* / surgery
Fluoroscopy
Heart Valve Prosthesis*
Humans
Transcatheter Aortic Valve Replacement* / adverse effects
Transcatheter Aortic Valve Replacement* / methods
Treatment Outcome