Transfemoral transcatheter aortic valve replacement in a patient with a history of artificial aortic arch replacement and stent implantation: a case report and strategies for a super-stiff approach.

内容摘要

Transfemoral transcatheter aortic valve replacement (TAVR) is challenging in patients with stiff and tortuous anatomy. In the present case, we presented a patient with super-stiff aortic arch (prior history of aortic arch replacement, stent implantation, and anastomotic fistula plugging) and a summary of strategies for managing such stiff approach. A 59-year-old man with symptomatic severe aortic stenosis and a super-stiff aortic arch underwent transfemoral TAVR. Techniques including buddy wire, balloon deflection, balloon-assisted tracking, snare assistance, and long sheath use were considered. Balloon-assisted tracking combined with a long sheath ultimately enabled successful TAVR. Supra-annular anchoring was also confirmed in this case. For patients with extremely stiff anatomy, multiple techniques may facilitate successful transfemoral TAVR. Furthermore, in bicuspid aortic valve cases, the narrowed supra-annular region can serve as an effective anchoring zone.