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 Video Presentation VS6. Trans-Catheter Aortic Valve Replacement Access, Complications and Bailouts

Manish Mehta1, Augustin J. Delago3, Edward V. Bennett2, Lewis W. Britton2, Mohammed C. El-Hajjar2, R Clement Darling MD1, Philip S. Paty MD1, Yaron Sternbach MD1
1The Vascular Group, The Institute for Vascular Health and Disease, Albany Medical College, The Center for Vascular Awareness Inc., Albany, NY; 2Albany Medical Center Hospital,Albany Medical College, Albany, NY; 3Capital Cardiology Associates, Albany Medical Center Hospital,Albany Medical College, Albany, NY.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has revolutionized treatments for patients with severe symptomatic aortic valve stenosis. In 2011, the FDA approved TAVR for surgically inoperable patients, and in 2012 for surgical high-risk patients. Currently randomized trials are under way evaluating the efficacy of TAVR for surgical low-risk patients. Similar to TEVAR, TAVR requires navigation of 22-25Fr sheaths and catheters across the aortoiliac segments and expose patients to the risks of arterial injury, bleeding and stroke. As vascular surgeons, we have participated in nearly 100 TAVR procedures and can attest to the importance of vascular surgeons’ involvement in not only limiting patient risks, but also in expanding the indications for patients with critical aortic stenosis and no other treatment options, as well as in managing bailouts following complications of these procedures.
 
TECHNICAL DESCRIPTION: This video presentation will focus on the implications of appropriate access during TAVR. Tips and tricks to the bailout procedures needed during misplaced aortic valves that require retrieval, as well as diagnosis and treatments for arterial injury during transfemoral and transapical TAVR.
 
AUTHOR DISCLOSURES: E. V. Bennett: Nothing to disclose; L. W. Britton: Nothing to disclose; R. Darling MD: Nothing to disclose; A. J. Delago: Nothing to disclose; M. C. El-Hajjar: Nothing to disclose; M. Mehta: Abbott Vascular, Cordis, Terumo Cardiovascular Systems, TriVascular, W.L. Gore & Associates, Lombard Medical Technologies, Bolton Medical, Medtronic, Aptus Endosystems, ev3 Endovascular, Maquet Cardiovascular Harvest Technologies, Research grants; ev3 Endovascular, W.L. Gore & Associates, Cordis, Trivascular, Consulting fees or other remuneration (payment); P. S. Paty MD: Nothing to disclose; Y. Sternbach MD: Medtronic, Speaker’s bureau.​
 
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Posted April 2013

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VascularWeb® is the prime source for all vascular health and disease information, and is presented by the Society for Vascular Surgery®. Its members are vascular surgeons, specialists, and vascular health professionals who are specialty-trained in all treatments for vascular disease including medical management, non-invasive procedures, and surgery.