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.