Page 36 - Journal of Structural Heart Disease Volume 5, Issue 5

Case Report
Journal of Structural Heart Disease, October 2019, Volume 5, Issue 5:229-236
DOI: https://doi.org/10.12945/j.jshd.2019.037.18
Received: November 11, 2018 Accepted: December 08, 2018 Published online: October 2019
Entrapped Stent Delivery Catheter Shaft After High Risk TAVI: Retrieval & Lessons Learned
Safwan Kassas, MD1*, Peter Fattal, MD2, Manoj Sharma, MD3
1 Structural cardiology, Michigan Cardiovascular Institute, Ascension ST Mary’s of Michigan, Saginaw, MI, USA
2 Cardiac Imaging, Michigan Cardiovascular Institute, Ascension ST Mary’s of Michigan, Saginaw, MI, United States 3 Cardiology Division, Covenant Health Care, Saginaw, MI, United States
Abstract
This case report will discuss a first reported compli- cation of very high coronary occlusion risk related to valve-in-valve (VIV) balloon expandable transcatheter aortic valve replacement (TAVR). As a protective mea- sure, an undeployed coronary stent was placed in the left anterior descending (LAD) artery. During the tran- scatheter heart valve (THV) deployment, the shaft of the left coronary stent catheter was firmly entrapped between the surgical valve posts and the balloon ex- pandable TAVR frame. This prohibited the retrieval and movement of the coronary stent catheter. There were two subsequent ruptures and detachments of the cor- onary stent catheter while attempting to retrieve the catheter. This report will provide measures to help avoid this entrapment using VIV/balloon expandable TAVR procedures. Steps taken to successfully manage this complication will be discussed.
Copyright © 2019 Science International Corp.
Key Words
Aortic stenosis • Retrieval of foreign body • Coronary occlusion
Introduction
Transcather aortic valve replacement for a deteri- orating surgical valve in the aortic position is an ap- proved therapy for both the self-expanding Medtron- ic and the balloon expandable EDWARDS valves. Coronary occlusion is a recognized complication of the TAVR procedure with a slightly higher incidence in the VIV procedures (as cited in Hamid et al., 2015). One of the protective strategies in high coronary oc- clusion risk TAVR is to place a coronary an undeployed stent in the coronary artery. If coronary occlusion complication occurs, the stent catheter can be pulled back and the left main or right coronary artery (RCA) ostium can be stented. The stent is extended out to reestablish coronary flow. This bail out strategy seems simple and catastrophic complications can take place, as in this case being reported.
Methods
A 63-year-old female patient with the following risk factors: hypertension, type II diabetes mellitus, dyslipidemia, and age. This patient does have a nor-
* Corresponding Author:
Safwan Kassas, MD
Inteventional Cardiology
Michigan Cardiovascular Institute
1015 S Washington Ave, Saginaw, MI 48601, USA
Tel. +1 248 219 2481; Fax: +1 248 792 7749; E-Mail: safwankassasmd@aol.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2019 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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