Mustafa Ahmad, Wei Chapman, Cinelli Michael, Khan Shahkar, Khan Danyal, Tamburrino Frank, Maniatis Gregory, Spagnola Jonathan
Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States.
World J Cardiol. 2025 Mar 26;17(3):101709. doi: 10.4330/wjc.v17.i3.101709.
Transcatheter aortic valve replacement (TAVR) can be performed through multiple access sites with the preferred approach being transfemoral. In patients with severe peripheral arterial disease and previous grafts, the safety of transfemoral access direct graft puncture, especially when performed twice within a short period, remains unclear compared to alternative access methods. We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty (BAV) and TAVR.
An 82-year-old man presented with dyspnea on exertion. Echocardiogram was significant for severe aortic stenosis. Following a heart team discussion, the patient was scheduled for a balloon valvuloplasty followed by staged TAVR. Based on pre-TAVR computed tomography angiogram, the aortobifemoral graft was deemed as an appropriate access site. Micropuncture needle was used to access the right femoral artery graft, and the sheath was upscaled to 10 Fr. He underwent successful intervention to ostial left anterior descending and left circumflex arteries, and BAV with 22 mm Vida BAV balloon. Hemostasis was achieved using Perclose. For TAVR, an 8 Fr sheath was inserted the right femoral bypass graft. The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal. A 5Fr sheath was used for left femoral bypass graft access. Patient underwent successful TAVR with 29 mm CoreValve. Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications.
BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.
经导管主动脉瓣置换术（TAVR）可通过多个入路部位进行，首选入路为经股动脉入路。在患有严重外周动脉疾病和既往有血管移植史的患者中，与其他入路方法相比，经股动脉入路直接穿刺血管移植处的安全性，尤其是在短时间内进行两次穿刺时，仍不明确。我们报告一例病例，展示了在球囊主动脉瓣成形术（BAV）和TAVR期间经股动脉入路直接穿刺血管移植处的安全性和有效性。
一名82岁男性因劳力性呼吸困难就诊。超声心动图显示严重主动脉瓣狭窄。经过心脏团队讨论，该患者计划先进行球囊瓣膜成形术，然后分期进行TAVR。根据TAVR术前计算机断层扫描血管造影，主动脉双股动脉移植血管被认为是合适的入路部位。使用微穿刺针穿刺右侧股动脉移植血管，然后将鞘管升级至10F。他成功地对左前降支和左旋支动脉开口进行了干预，并使用22mm的Vida BAV球囊进行了BAV。使用Perclose实现了止血。对于TAVR，在右侧股动脉旁路移植血管中插入了一个8F鞘管。动脉切开处先用两个Perclose ProGlide预先闭合，然后将入路扩大至18F Gore DrySeal。使用一个5F鞘管穿刺左侧股动脉旁路移植血管。患者使用29mm CoreValve成功完成了TAVR。右侧入路部位使用2个Perclose、左侧使用1个Perclose成功实现了止血，术后无出血并发症。
通过直接穿刺主动脉双股动脉旁路移植血管进行BAV和TAVR是可行且安全的，使用Perclose可成功止血。
