Asian Journal of Cardiology Research

Percutaneous Aortic Valve Implantation (TAVI) in a Patient with Severe Peripheral Arterial Disease: A Case Report

Mouna Rahmi *

Department of Cardiology, University International Hospital Cheikh Khalifa Casablanca, Morocco.

Fatima Zahra Merzouk

Department of Cardiology, University International Hospital Cheikh Khalifa Casablanca, Morocco.

Amale EL Ouarradi

Department of Cardiology, University International Hospital Cheikh Khalifa Casablanca, Morocco.

Mohamed Sabry Youssef Tijani

Department of Cardiology, University International Hospital Cheikh Khalifa Casablanca, Morocco.

Rachida Habbal

Department of Cardiology, University International Hospital Cheikh Khalifa Casablanca, Morocco.

*Author to whom correspondence should be addressed.

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Abstract

Background: Trans-Aortic-Valve-Implantation (TAVI) is an innovative technique for the management of patients with symptomatic aortic stenosis. However, it is still associated with a non-negligible rate of vascular complications. In this article we discuss the difficulties of the vascular approach of TAVI.

Case Presentation: We report a case of a 72 years old male, hypertensive, chronic smoker, known coronary carrier for 4 years of stenting on the IVA and circumflex with severe aortic stenosis. Admitted for TAVI implantation because of the high surgical risk according to EuroScoreII. Clinical examination note a systolic murmur of aortic stenosis radiating to the neck vessels without signs of heart failure (HF). TTE shows a serrated aortic stenosis (area 0.7cm², mean gradient 58mmHg, Vmax 6m/s). Pre-TAVI arteriography reveals very tight stenosis at the origin of the left primitive iliac artery and tight truncal stenosis of the right primitive iliac artery. Catheterization of the right primitive iliac artery was performed with satisfactory angiographic control. After surgical approach of the right femoral artery and balloon dilatation of the right common iliac artery, crossing of the calcified aortic stenosis with a Terumo guide and AL1 probe, placement of an intra-GV Pitail probe with pressure recording, placement of the SAPIEN 3 prosthesis (23mm), agiographic control showed no para-valvular aortic insufficiency. The postoperative course was straightforward, with no complications noted and a good result on postoperative echocardiography. 

Conclusion: Peripheral arterial disease is common in patients undergoing TAVI and is associated with unfavorable early and late clinical outcomes. Assessment of peripheral arterial disease prior to TAVI is crucial not only to determine pathways, but also to prepare for potential vascular complications.

 

Keywords: TAVI, aortic stenosis, iliac stenosis, femoral approach difficulty

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References

Auffret V, Lefevre T, Van Belle E, Eltchaninoff H, Iung B, Koning R, et al. Temporal trends in transcatheter aortic valve replacement in France: France 2 to FRANCE

TAVI. J Am Coll Cardiol. 2017;70:42–55. DOI: 10.1016/j.jacc.2017.04.053

Kaluski E, Khan SU, Sattur S, Sporn D, Rogers G, Reitknecht F. Arteriotomy site complication during transcatheter aortic valve replacement: Ipsilateral wire protection and bailout. Cardiovasc Revasc Med. 2018;19:724–30. DOI: 10.1016/j. carrev.2018.02.004

Spaulding, Christian. "Percutaneous aortic valve replacement: the approaches." Bulletin of the National Academy of Medicine. 2027;(2018):1615-1626.

Francone M, Budde RPJ, Bremerich J, Dacher JN, Loewe C, Wolf F. CT and MR imaging prior to transcatheter aortic valve implantation: Standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology (ESCR). Eur Radiol. 2020;30: 2627– 50.DOI: 10.1007/s00330-019-06357-8

Stewart BF, Siscovick D, Lind BK. Clinical factors associated with calcific aortic valve disease. Cardiovascular health study. J Am Coll Cardiol. 1997;29:630–634.

Pohle K, Ma¨ffert R, Ropers D. Progression of aortic valve calcification: Association with coronary atherosclerosis and cardiovascular risk factors. Circulation 2001;104:1927–1932

Hammamia, Mohamed Ben. Vascular complications of Trans-Aortic-Valve-Implantation (TAVI) Vascular complications of Trans-Aortic-Valve-Implantation.

Nardi, Giulia. Peripheral intravascular lithotripsy for transcatheter aortic valve implantation: a multicenter observational study. EuroIntervention. 2022;17.17 (2022):e1397.

Vascular access in patients with peripheral arterial disease undergoing TAVR: The hostile registry JACC cardiovasc interv. 2023;16(4):396-411. DOI: 10.1016/j.jcin.2022.12.009

EPUB: 2023 Jan 18

Lu, Henri. TAVI: A literature review of alternative routes to trans-femoral access." La Presse Médicale Formation 1.3. 2020; 249-256.

Denimal T, Delhaye C, Pi erache A, Robin E, Modine T, Moussa M, et al. Feasibility and safety of transfemoral transcatheter aortic valve implantation performed with a percutaneous coronary intervention-like approach. Arch Cardiovasc Dis 2021 S1875-2136(21)00052-8. DOI: 10.1016/j.acvd.2020. 12.007

Nguadi, Jaouad, Meryem Bennani, Youssef Lahmouz, Zaynab Mouhib, Abdelilah Benelmekkki, Najat Mouine, Hicham Bouzelmat, Ali Chaib, Aatif Benyass. The management of degenerative complete heart block in the time of coronavirus. Asian Journal of Cardiology Research. 2022;5(1):273-79.Available:https://journalajcr.com/index.php/AJCR/article/view/108.

Fusini L, Mirea O, Tamborini G, Muratori M, Gripari P, Cefalù C, Ghulam Ali S, Maffessanti F, Andreini D, Pontone G, Bartorelli AL. Incidence and severity of atherosclerotic cardiovascular artery disease in patients undergoing TAVI. The International Journal of Cardiovascular Imaging. 2015;31:975-85.

van den Boogert TP, Vendrik J, Claessen BE, Baan J, Beijk MA, Limpens J, Boekholdt SM, Hoek R, Planken RN, Henriques JP. CTCA for detection of significant coronary artery disease in routine TAVI work-up: A systematic review and meta-analysis. Netherlands Heart Journal. 2018;26:591-9.