Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Cardiovascular Medicine, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
Catheter Cardiovasc Interv. 2021 Sep;98(3):E486-E489. doi: 10.1002/ccd.29580. Epub 2021 Jan 22.
Self-expanding prostheses for transcatheter aortic valve replacement (TAVR), which can be recaptured, provide us the option of repositioning for a more accurate placement. We report a very rare case in which the recapture of CoreValve Evolut R (Medtronic, Minneapolis, Minnesota) to correct the implantation depth during the deployment could not be achieved. We planned TAVR with a 23 mm Evolut R prosthesis for a 92-year-old female with severe aortic stenosis and tightly bent thoracic aorta. During the first deployment attempt, the implantation depth was greater than we expected at 2/3 deployment. They tried to recapture and reposition the prosthesis, but the prosthesis was not re-sheathed into the capsule of the delivery system. The prosthesis could not be recaptured despite a repeat attempt, and they were forced to deploy the device as it was. The prosthesis was deployed very carefully and implanted successfully without a pop-up into the ascending aorta. At a later date, this situation was replicated in vitro and was found that the distal segment of the capsule became deformed, increasing the resistance to rotating the grip handle.
自扩张假体经导管主动脉瓣置换术（TAVR），可回收，为我们提供了重新定位以实现更准确放置的选择。我们报告了一个非常罕见的病例，其中 CoreValve Evolut R（美敦力，明尼苏达州明尼阿波利斯）的回收无法实现，以纠正在部署过程中的植入深度。我们计划为一名 92 岁患有严重主动脉瓣狭窄和胸主动脉严重弯曲的女性进行 23mm Evolut R 假体 TAVR。在第一次部署尝试中，植入深度在 2/3 部署时大于我们的预期。他们试图回收并重新定位假体，但假体无法重新套入输送系统的胶囊中。尽管再次尝试，假体仍无法回收，他们被迫将设备强行部署。假体被非常小心地部署，并成功植入，没有弹出到升主动脉。后来，在体外复制了这种情况，并发现胶囊的远端段变形，增加了旋转握柄的阻力。
