Transradial balloon aortic valvuloplasty: a case report

    Authors

    Keywords

    balloon aortic valvuloplasty, aortic stenosis, transradial, frail

    DOI

    https://doi.org/10.15836/ccar2021.297

    Full Text

    Background and Aims: Balloon aortic valvuloplasty (BAV) is usually used as a bridge to percutaneous or surgical aortic valve intervention. While BAV is traditionally performed via transfemoral approach, transradial BAV is a safe and feasible alternative ( 1 , 2 ). We present a case of BAV performed via transradial access at the University Hospital Centre Split, which to our knowledge, is a first time this procedure was performed in Croatia. Protocol presentation : 86-year-old lady was hospitalized on the vascular surgery department with symptoms of critical limb ischemia. Upon preoperative examination a strong heart murmur was noticed, with ECG changes suggestive of left ventricle strain. An echo was performed revealing an ejection fraction of 30%, and a low flow - low gradient aortic stenosis (MPG 38 mm Hg, and Vmax 3.7 m/s). A CTA of the aorta revealed a chronic infrarenal dissection and an occlusion of the right iliac artery, basically disabling the classic femoral access. We decided to perform a balloon aortic valvuloplasty using radial access, as described in the SOFTLY-II trial ( 3 ). Right radial access was obtained using a 6F sheath and a contralateral radial artery was cannulated for pressure monitoring during the procedure and a 5F sheath was placed in the femoral vein. After aortic valve crossing, a 260cm wire (Medtronic CONFIDA) was placed in the left ventricle apex. At that point the 6F sheath was exchanged with an 8F sheath ( Figure 1 ). A non-compliant 18x40mm (Bard Atlas Gold) balloon was used during rapid pacing over the wire at 180/min (positive electrode at the short wire placed in femoral vein and negative on the wire in the LV). Periprocedural analgosedation with propofol in the bolus-continuous infusion scheme was used during the rapid pacing. Vascular access planning and feasibility. Conclusions : Transradial BAV is a safe alternative to transfemoral BAV, especially in old and frail adults waiting for TAVR, while minimizing the bleeding risk, and femoral access complications.

    Cardiologia Croatica
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    Transradial balloon aortic valvuloplasty: a case report

    Extended Abstract
    Issue9-10
    Published
    Pages297
    PDF via DOIhttps://doi.org/10.15836/ccar2021.297
    balloon aortic valvuloplasty
    aortic stenosis
    transradial
    frail

    Authors

    Nikola Crnčević*ORCIDUniversity Hospital Centre Split, Split, Croatia
    Andrija MatetićORCIDUniversity Hospital Centre Split, Split, Croatia
    Frane RunjićORCIDUniversity Hospital Centre Split, Split, Croatia
    Ivica KristićORCIDUniversity Hospital Centre Split, Split, Croatia

    Full Text

    Background and Aims: Balloon aortic valvuloplasty (BAV) is usually used as a bridge to percutaneous or surgical aortic valve intervention. While BAV is traditionally performed via transfemoral approach, transradial BAV is a safe and feasible alternative ( 1 , 2 ). We present a case of BAV performed via transradial access at the University Hospital Centre Split, which to our knowledge, is a first time this procedure was performed in Croatia. Protocol presentation : 86-year-old lady was hospitalized on the vascular surgery department with symptoms of critical limb ischemia. Upon preoperative examination a strong heart murmur was noticed, with ECG changes suggestive of left ventricle strain. An echo was performed revealing an ejection fraction of 30%, and a low flow - low gradient aortic stenosis (MPG 38 mm Hg, and Vmax 3.7 m/s). A CTA of the aorta revealed a chronic infrarenal dissection and an occlusion of the right iliac artery, basically disabling the classic femoral access. We decided to perform a balloon aortic valvuloplasty using radial access, as described in the SOFTLY-II trial ( 3 ). Right radial access was obtained using a 6F sheath and a contralateral radial artery was cannulated for pressure monitoring during the procedure and a 5F sheath was placed in the femoral vein. After aortic valve crossing, a 260cm wire (Medtronic CONFIDA) was placed in the left ventricle apex. At that point the 6F sheath was exchanged with an 8F sheath ( Figure 1 ). A non-compliant 18x40mm (Bard Atlas Gold) balloon was used during rapid pacing over the wire at 180/min (positive electrode at the short wire placed in femoral vein and negative on the wire in the LV). Periprocedural analgosedation with propofol in the bolus-continuous infusion scheme was used during the rapid pacing. Vascular access planning and feasibility. Conclusions : Transradial BAV is a safe alternative to transfemoral BAV, especially in old and frail adults waiting for TAVR, while minimizing the bleeding risk, and femoral access complications.