The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Delivery Catheter System Fracture during Transcatheter Aortic Valve Implantation

DOI: 10.4244/EIJ-D-20-00748

1. Department of Cardiology, Galway University Hospital, Galway, Ireland, Ireland
2. Department of Cardiology, Galway University Hospital, Galway, Ireland.
3. Department of Cardiology, Galway University Hospital, Galway, Ireland. National University of Ireland Galway, Galway, Ireland.

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An 87-year-old male with severe symptomatic aortic stenosis was accepted for transcatheter aortic valve implantation (TAVI) via transfemoral approach (Figure 1). Multi-slice computed tomography demonstrated moderately calcified and tortuous iliofemoral arteries (minimal lumen diameter 10.4mm), and a moderately calcified and angulated trileaflet aortic valve (aortic annulus perimeter 85.0mm; aortic root angulation 45º), suitable for implantation of a 34mm Evolut R valve (Medtronic, Dublin, Ireland) as per standard practice of our centre. After vascular pre-closure with two Perclose devices (Abbott Vascular, California, USA) and valve pre-dilatation with a 24mm Nucleus balloon (Numed, Cornwall, Canada), a 16Fr EnVeo Pro delivery catheter system (DCS) (Medtronic, Dublin, Ireland) easily traversed the iliofemoral vessels and the aortic valve. Deployment of the transcatheter heart valve (THV) was challenging due to recurrent migration towards the left ventricle, despite guide wire manipulation and rapid ventricular pacing.

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