Expanding the Eligibility for Transcatheter Aortic Valve ImplantationThe Trans-Subclavian Retrograde Approach Using the III Generation CoreValve Revalving System
Chiara Fraccaro, MD*,*,
Massimo Napodano, MD*,
Giuseppe Tarantini, MD, PhD*,
Valeria Gasparetto, MD*,
Gino Gerosa, MD ,
Roberto Bianco, MD,
Raffaele Bonato, MD ,
Demetrio Pittarello, MD,
Giambattista Isabella, MD*,
Sabino Iliceto, MD, PhD*,
Angelo Ramondo, MD*
* Department of Interventional Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
Department of Cardiac Surgery, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
Institute of Anesthesia, University of Padova, Padova, Italy
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Figure 1 Computed Tomographic Angiography of Left Subclavian Artery
Computed tomographic angiography performed in order to detect size, course, and calcification of left subclavian artery, aortic arch, and ascending aorta.
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Figure 2 Technical Steps of Left Subclavian Approach
After incision of cutaneous and subcutaneous tissues (A), a surgical cut-down of left subclavian artery is performed (B). Then the artery is punctured (C) and a 7-F sheath is introduced (D). After performing ascending aorta angiogram, crossing the aortic valve and detecting transvalvular gradient, the previously placed sheath is then exchanged for the larger 18-F long sheath (E). After revalving therapy, the subclavian artery is restored by direct suture. Finally, subcutaneous and cutaneous tissues were sutured (F).
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Figure 3 Aortic Revalving Therapy
The CoreValve Revalving System device was carefully introduced by the sheath and advanced throughout the aorta into the aortic root (A to C). After careful checking by angiography, the valve was released (D to E). Post-revalving ascending aorta angiogram demonstrates the correct positioning of the device, without peri-prosthesis regurgitation and with patency of coronary ostia (F).
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