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Minimizing the risk for left ventricular rupture during transcatheter aortic valve implantation by reducing the presence of stiff guidewires in the ventricle
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
Sahlgrens Univ Hosp, Sweden.
Inst Pharmacol and Prevent Med, Germany.
Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
2019 (English)In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 29, no 3, p. 365-370Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The presence of a stiff guidewire in the apex of the left ventricle (LV) is a known risk factor for LV perforation. Our goal was to minimize the risk of LV rupture during transcatheter aortic valve implantation (TAVI) by omitting the interaction between the stiff guidewire and the LV apex using a modified procedure. METHODS: A TAVI protocol designed to allow minimal interaction between a stiff guidewire and the LV was developed in Linkoping University Hospital in Sweden. A total of 316 patients were treated exclusively by this approach between March 2014 and May 2018. RESULTS: All procedures were completed successfully. There were no cases (0%) of ventricular perforation. Only 1 patient (0.3%) had a pericardial effusion, and it was due to annulus rupture. There was 1 case of acute kidney injury (0.3%). Five patients (1.6%) required a new permanent pacemaker. Stroke occurred in 3 patients (0.9%). No patient had valve embolization. Vascular complications were experienced by 6 patients (1.9%). A mild paravalvular leak occurred in 27 (8.5%) patients. At 30 days post-TAVI, 6 patients (2%) had died. The mortality rate at 1 year was 8.6% (n = 20/232). CONCLUSIONS: Our series shows that TAVI without the prolonged use of a stiff guidewire in the LV apex is feasible. The risk of LV perforation is eliminated by this approach, and other procedural complications are limited.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS , 2019. Vol. 29, no 3, p. 365-370
Keywords [en]
stiff guidewire; transcatheter aortic valve implantation; aortic valve stenosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-162082DOI: 10.1093/icvts/ivz107ISI: 000493292400006PubMedID: 31135035OAI: oai:DiVA.org:liu-162082DiVA, id: diva2:1371324
Available from: 2019-11-19 Created: 2019-11-19 Last updated: 2019-11-19

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Nielsen, Niels ErikBaranowski, Jacek
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in LinköpingDepartment of Clinical Physiology in Linköping
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