Transcatheter aortic valve replacement (TAVR) has become increasingly common as the indications expanded to include valve-in-valve (ViV) applications and a wider patient population with lower surgical risk. Intra-operative coronary arterial occlusion remains a significant source of morbidity, particularly in ViV applications or cases with high-risk anatomy. We present a novel technique for coronary artery protection utilizing a guide extension catheter to secure coronary access during valve deployment and a ViV case demonstration in a patient with prior surgical aortic valve replacement.
Keywords: GuideLiner; TAVR; coronary protection; transcatheter aortic valve replacement; valve-in-valve; valvular heart disease.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that has become an alternative to major cardiac surgery for replacing the aortic valve. A potential serious complication during this procedure is obstruction of the major coronary blood vessels supplying the heart itself. This may occur during deployment of the prosthetic aortic valve, a process which can inadvertently lead to blockage of the opening of the arteries of the heart. We present a novel method for protecting the opening of these arteries during TAVR to reduce the risk of this complication.