Page 35 - Journal of Structural Heart Disease Volume 3, Issue 1

Case Report
Journal of Structural Heart Disease, February 2017, Volume 3, Issue 1:28-34
DOI: http://dx.doi.org/10.12945/j.jshd.2017.16.007
Received: May 10, 2016 Accepted: August 3, 2016 Published online: February 2017
Use of a Palmaz Intrahepatic Stent for Fixation
of a CoreValve During Treatment of Native Aortic
Valve Regurgitation
Nirmal Sunkara, MD1*, Anwar Tandar, MD1, Amit N. Patel, MD1,2, Mary Hunt Martin, MD1,2, Frederick Welt, MD1
1 Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA 2 Primary Children’s Hospital, University of Utah, Salt Lake City, Utah, USA
Abstract
Transcatheter aortic valve replacement has been ap- proved and is widely used in the USA for severe calci c aortic stenosis in the high risk inoperable patient. While not approved in patients with native aortic regurgita- tion (NAVR), there are numerous reports of its use in such patients who are not deemed acceptable surgical candidates. The technical challenges in the NAVR pop- ulation include lack of uoroscopic markings due to absence of annular or cusp calci cation, increased risk of malpositioning and a risk of residual aortic regurgi- tation resulting in a high rate (18.8 percent) of need for second valve implantations [1].
Nevertheless, there are numerous reports of TAVR for NAVR. Roy et.al in a registry study of 43 patients from 14 di erent countries showed feasibility of CoreValve implantation in extreme operative risk patients with NAVR without aortic stenosis [1]. The implantation of a CoreValve was successful in 97.7% of cases, however the Valve Academic Research Consortium (VARC)-de ned procedural success was only 74.4% due to the need for a second valve.
We submit the rst description of using the radial force of a Palmaz biliary stent to a x the upper portion of a CoreValve and mitigate the issue of ventricular migra- tion of the valve in treatment of a NAVR patient with TAVR. We feel this should be considered as an addition- al tool in the armamentarium of physicians treating this challenging subset of patients.
The Palmaz XL stents are balloon expandable stainless steel prostheses. They have a closed cell design which gives them high radial strength and are designed for an expansion range of 10 mm – 25 mm while maintain- ing their radial strength of 12 psi. Their foreshortening ranges between 2.5% at 10 mm and 23% at 25 mm [4]. This foreshortening has to be taken into account when adjusting the overlap portion when using as described above with the CoreValve.
Copyright © 2017 Science International Corp.
Key Words
Aortic regurgitation • TAVR • Core valve • Palmaz stent
Introduction
Transcatheter aortic valve replacement (TAVR) has been approved and is widely used in the United States for severe calci c aortic stenosis in high-risk inoperable patients. Although not approved for pa- tients with native aortic regurgitation (NAVR), there are several reports of its use in such patients who are not deemed acceptable surgical candidates. Patients with NAVR pose numerous technical challenges. The absence of annular or cusp calci cation in NAVR means a lack of uoroscopic markings, which can make valve positioning more challenging. The lack of
* Corresponding Author:
Nirmal T. Sunkara, MD
Division of Cardiovascular Medicine
University of Utah
30 N 1900 E, #4A100, Salt Lake City, UT 84101, USA
Tel. +1 657 333 2079, Fax: +1 888 433 9843, E-Mail: nirmalsunkara@gmail.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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