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Case Report
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tween the surgical frame and the SAPIEN 3 frame. A quick adjustment or pull on the coronary stent cath- eter shaft could have been made to avoid the entrap- ment. It is advised to use the following for valve-in- valve TAVR with high occlusion risk where balloon expandable valves are used. Close attention must be paid to the course of guide catheters, wires and coro- nary stent catheters to avoid entrapment. Monitoring for any interaction between the coronary stent cathe- ter and the expanding THV frame during deployment as any interaction should indicate the coronary stent catheter is coursing in-between the THV and the sur- gical frames. Careful selection of guide catheters is important, such as using a Judkins left or short tip artery access as previously noted. Using general an- esthesia with transesophageal echocardiogram (TEE) guidance allows for the use of smaller sized balloon expandable valves. Slight underfilling and lower de- ployment is desired as the end result.
Conclusion
Transcatheter aortic valve replacement is gradually becoming the main stream treatment for aortic valve
stenosis. The skills to perform an interventional pro- cedure are important, but more knowledge and train- ing are indicated to perform the procedure success- fully. Operators need to be able to perform careful analysis of the diagnostic data available to them and be able to predict potential risks and complications. Operators also need to be proficient in the various devices commercially available to them. Every oper- ator must be ready to manage complications and be aware that potential unknown difficulties can occur. There is always a first time for everything.
Conflict of Interest
Safwan Kassas recieved a research grant from Ed- wards Life Science: Proctor Boston Scientific Inc.
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References
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2. Dvir D, Leipsic J, Blanke P, Ribeiro HB, Kornowski R, Pichard A, et al. Coronary Obstruction in Transcatheter Aortic Valve- in-Valve Implantation Preprocedural Eval- uation, Device Selection, Protection, and Treatment. Circ Cardiovasc Interv. 2015;8:1. pii: e002079. DOI: https://doi.org/10.1161/ CIRCINTERVENTIONS.114.002079
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Journal of Structural Heart Disease, October 2019
Volume 5, Issue 5:229-236
Cite this article as: Kassas S, Fattal P, Sharma M. Entrapped Stent Delivery Catheter Shaft After High Risk TAVI: Retrieval & Lessons Learned. Struc- tural Heart Disease. 2019;5(5):229- 236. DOI: https://doi.org/10.12945/j. jshd.2019.037.18