A Simplified Protocol for Transcatheter Aortic Valve Implantation that Reduces Procedure-Related Risk
- *Corresponding Author:
- Henrik C Ahn
Department of Cardiothoracic Surgery
Linköping University Hospital, Linköping, Sweden
E-mail: [email protected]
Received March 29, 2016; Accepted April 26, 2016; Published April 30, 2016
Citation: Baranowski J, Nielsen NE, Ahn HC (2016) A Simplified Protocol for Transcatheter Aortic Valve Implantation that Reduces Procedure-related Risk. J Cardiovasc Dis Diagn 4:241. doi:10.4172/2329-9517.1000241
Copyright: © 2016 Baranowski J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objectives: Transcatheter Aortic Valve Implantation is now a well-established procedure and continuous development has improved the technique. The object of this paper is to describe the successive steps taken at our department to improve our protocol, resulting in a more effective and patient-safe procedure.
Design: An echo-guided method for aortic cusp alignment was used in 229 patients. In 139 patients pre-dilatation was excluded from the protocol. In the last 47 of the patients we exchanged the stiff guide-wire in the left ventricle with a soft wire for valve placement.
Results: There was a significant decrease in the use of contrast medium during the period with 90% of patients receiving less than 50 ml contrast and 35% no contrast at all. In more than half the patients we only used rapid pacing in association with deployment of the stent valve. We had six cases ofpericardial bleeding due to penetration of the stiff guide wire through the left ventricular (LV) wall. This complication was avoided in all subsequent patients where we exchanged the stiff catheter to a soft guidewire in the ascending aorta before introduction of the wire and stent valve into the LV.
Conclusions: We have successively modified our standard protocol for implantation of a balloon-expandable transcatheter aortic valve. This has simplified the procedure and reduced the risk for certain procedure-related complications.