Extended-length sheaths for TAVI in hostile aortic anatomy

In patients with severe aortic stenosis and a hostile aortic anatomy scheduled for transcatheter aortic valve implantation (TAVI), concerns may arise regarding the risk of vascular complications and a previously reported increased stroke risk12. One practical strategy is to use an extended-length introducer sheath that bypasses the problematic aortic segment(s). However, data supporting this approach remain limited.

In this report, we describe the feasibility, safety, and technical considerations of using a 65 cm long GORE DrySeal Flex introducer sheath (W. L. Gore & Associates) in patients with hostile aortic anatomies undergoing transfemoral (TF)-TAVI with self-expanding valves (SEV). The DrySeal Flex is a fixed-diameter sheath featuring a hydrophilic coating and a long-tapered dilator. Designed for flexibility, the sheath offers sufficient support and kink resistance. Due to its increased length, the sheath is placed over a stiff guidewire and positioned in the left ventricle. The sheath is advanced across the aortic arch and remains in place until delivery of the transcatheter heart valve (THV) at the level of the aortic annulus or until completion of all procedural steps – such as...