Page 49 - Journal of Structural Heart Disease Volume 4, Issue 5

Case Report 244
Figure 3. Post procedural computed tomography scan after 3 weeks showing widely patent LM stent protruding toward the valve frame (Panel A) together with three-dimensional reconstruction (Panel B).
may also happen after the procedure. We also believe that smaller stent protrusion may facilitate left coro- nary engagement in the future and may theoretically reduce the risk of stent thrombosis. Of note, using our “T-stenting” technique, we were able to deliver an ad- ditional two stents to the LAD through the LM stent without any problems. Retrospectively, we believe that additional LAD stenting was required because there was a distal edge dissection from the initial LM stent which extended into the diffusely diseased proximal and mid LAD. Beside “chimney” and our “T-stenting” techniques, the third option to prevent LM occlusion during TAVR is the recently described "BASILICA" technique with modulating of the native valve leaflet. A single leaflet tear, which would prevent coronary occlusion, is made by leaflet wire traversal and snaring followed by slicing. To our knowledge, this technique has been described so far in only six “valve-in-valve” procedures and one native aortic ste- nosis. We did not use “BASILICA” because of the lack of experience and fear to increase stroke risk when manipulating with a heavily calcified cusp. However, when discussing any of the herein described LM pro- tection techniques during TAVR, it is important to no-
tice that the number of reported patients is still very limited and long-term efficacy and safety remains to be proven.
Acknowledgements
We are grateful to Natasa Suligoj Cernic, MD for echocardiography and MC Medicor chief medical of- ficer, Metka Zorc, MD, PhD.
Conflict of Interest
Marko Noc and Branko Cveticanin have no relevant conflict of interest.
Saibal Kar reports research grant from Edwards Lifesciences and research grants and consultation fees from Abbott Vascular and Boston Scientific
Oscar Mendiz reports proctorship for CoreV- alve (Medtronic) and consultation fees from Abbott Vascular.
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Journal of Structural Heart Disease, October 2018
Volume 4, Issue 5:240-245