Procedures
Aortic annulus, root, and valve morphology were assessed using both contrast-enhanced MDCT and transesophageal echocardiography (TEE). The THV severed to anatomically orient the position for optimal implantation along with the help of the clasper (Figure 3). Evaluations of valve function and quantification of residual aortic regurgitation after TAVR were performed by TEE and angiography (Figure 3, 4).
The procedure was performed in a hybrid operation room under general anesthesia while a full cardiopulmonary bypass circuit was on standby. A pigtail catheter was advanced into the ascending aorta via the right femoral artery and an aortogram was performed. TEE was used for the evaluation of the valve pathology. A temporary pacemaker was placed, and a 4 cm incision in the coastal space at the heart’s apex was made. Aortic root angiography was used to identify the aortic sinus and annulus. A J-Valve was crimped into the Ausper-AS delivery system. The delivery system was inserted into the left ventricle through the apex and advanced into a supra-annular position under fluoroscopic guidance.
The three U-shaped anchor rings were ultimately deployed, pulled down and tactile feedback was checked to ensure that the three anchors were inside the aortic sinus (Figure 3A/E). Then aortic root angiography was reperformed. Next, the top part of the delivery system in which the valve was stored was retrieved back gently into the annular plan (Figure 3B/F) and deployed without rapid ventricular pacing (Figure 3 C/G). The aortic root angiography was used to monitor PVL (Figure 3D/H). The functionality was also confirmed via TEE.