Cusp overlap technique for transcatheter self-expanding aortic valve implantation

Transcatheter aortic valve implantation (TAVI) may cause atrioventricular conduction disturbances and, consequently, the necessity for permanent pacemaker implantation (PPI). This is because the His bundle surfaces at the basal part of the membranous septum (in the neighbourhood of the non-coronary cusp) and implant depth greater than the length of the membranous septum may interfere with the conduction system [1]. To mitigate this risk, the valve should be implanted at a high position to minimize the contact of the valve frame with the base of membranous septum. During TAVI, the valve is usually positioned in a coplanar fluoroscopic projection with 3 cusps view, but for a self-expanding va…

Balloon aortic valvuloplasty, Impella insertion and complex coronary intervention: is this all feasible fully percutaneously via upper limb access?

Complex high-risk indicated patients (CHIP) with a limited vascular access constitute a real challenge for percutaneous coronary interventions (PCI), particularly if they require mechanical circulatory support devices. A 73-year-old man with recent non-ST segment elevation myocardial infraction, depressed left ventricular function (ejection fraction, 40%), aortic stenosis (max/mean gradient, 50/32 mm Hg; aortic valve area and its index, 1.0 cm2 and 0.5 cm2/m2) and numerous comorbidities (including recently diagnosed lung cancer in the initial phase) was scheduled by the heart team for balloon aortic valvuloplasty (BAV) and Impella-supported complex PCI of the left main (LM) and the left ant…

Fully percutaneous insertion and removal of the Impella CP via a subclavian approach

The Impella (Abiomed) is a mechanical circulatory support device which augments cardiac output, but may also unload a left ventricle during venoarterial extracorporeal membrane oxygenation (ECMO) [1]. However, the Impella requires an access to a large artery and this may be problematic in a severe peripheral arterial disease. The presented case demonstrates how to insert and remove the Impella CP via a subclavian approach without surgical cutting.

MitraClip Implantation in Holography.

Fully Percutaneous Transaxillary Aortic Valve Replacement With Effective Bailout Plan for Vascular Complications.