San Raffaele Scientific Institute and Columbus Hospitals, Milan, Italy.
Catheter Cardiovasc Interv. 2010 Apr 1;75(5):784-93. doi: 10.1002/ccd.22238.
To describe results from a novel percutaneous technique designed to minimize the risk of hemorrhage in the event of a major complication during transcatheter aortic valve implantation.
Vascular access management is a major challenge in transfemoral TAVI due to the large introducer sheathes required.
Fifty-two pts underwent TAVI between November 2007 and March 2009. Of these, 37 received an Edwards-Sapien Valve (23 mm valve: 17/37; 26 mm valve: 20/37) whilst 15 patients received a CoreValve (26 mm valve: 6/15; 29 mm valve: 9/15). Using a crossover technique, the opposing femoral artery was cannulated with a 7Fr long sheath. This allowed contralateral passage of a balloon and inflation in the proximal iliac. The sheath was then removed and Prostar sutures tied in a dry field. Balloon optimization of the puncture site was performed as required.
In three subjects, elective surgical repair was undertaken due to excessive femoral arterial calcification. In the remaining 49, the crossover technique was employed and closed with two Prostar devices (Edwards-Sapien) or one (CoreValve). There were serious "on-table" complications in seven patients, six due to the large introducer sheathes used in the TAVI procedure-iliac avulsion, two iliac dissections, iliac perforation, common femoral perforation and scrotal hematoma. All were repaired safely by combined surgical and endovascular techniques, using the crossover technique to ensure patient stability. All made a good recovery and were independently ambulant at discharge.
Using crossover balloon inflation as an adjunct to Prostar closure may be helpful for managing TAVI vascular access sites.
描述一种新的经皮技术的结果，该技术旨在降低经导管主动脉瓣植入术（TAVI）过程中发生重大并发症时出血的风险。
由于需要使用大的导入鞘，经股动脉 TAVI 的血管入路管理是一个主要挑战。
2007 年 11 月至 2009 年 3 月期间，52 例患者接受了 TAVI。其中 37 例接受了 Edwards-Sapien 瓣膜（23 毫米瓣膜：17/37；26 毫米瓣膜：20/37），而 15 例患者接受了 CoreValve（26 毫米瓣膜：6/15；29 毫米瓣膜：9/15）。使用交叉技术，对相对的股动脉进行了 7Fr 长鞘管的插管。这允许对侧通过球囊并在近端髂骨充气。然后将鞘管取出，并在干燥的场地上系上 Prostar 缝线。根据需要进行球囊优化穿刺部位。
在 3 名患者中，由于股动脉钙化过多，选择了择期手术修复。在其余 49 名患者中，采用了交叉技术，并使用两个 Prostar 装置（Edwards-Sapien）或一个（CoreValve）进行了闭合。在 7 名患者中发生了严重的“术中”并发症，其中 6 名患者是由于 TAVI 过程中使用的大导入鞘管导致的-髂骨撕脱、2 例髂骨夹层、髂骨穿孔、股总动脉穿孔和阴囊血肿。所有患者均通过联合手术和血管内技术安全修复，使用交叉技术确保患者稳定。所有患者均恢复良好，出院时均可独立行走。
将交叉球囊充气作为 Prostar 闭合的辅助手段可能有助于管理 TAVI 血管入路部位。
