Author + information
- Manolis Vavuranakis, MD⁎ ( )(, )
- Dimitrios Vrachatis, MD and
- Christodoulos Stefanadis, MD
- ↵⁎First Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, 13 Astypaleas Str., Anoixi, 14569 Attiki, Greece
In a recent issue of JACC: Cardiovascular Interventions, Latib et al. (1) presented images of a technique for repositioning a just-implanted CoreValve (Medtronic, Minneapolis, Minnesota) aortic bioprosthesis with a snare.
The “Snare” technique is a bail-out method, which has been described in detail by Vavouranakis et al. (2). This technique may be applied when the aortic prosthesis is initially positioned too low. A low deployment of the prosthesis would result in an angiographically significant aortic insufficiency (AI). In fact, an AI observed during implantation procedure could as well be attributed to an incomplete deployment of the valve. If this were the case, post-implantation balloon inflation would fully expand the frame of the prosthesis and the “skirt” of the prosthesis would effectively seal any perivalvular leaks. However, in the case of a truly low valve positioning, post-implantation inflation(s) would not improve the observed AI. In this case, the snaring and pulling technique might be used.
A critical point, regarding the “Snare” repositioning technique, is that the operator, when trying to capture the loop of the prosthesis with the snare, should be aiming at the loop that corrects the deep valve positioning. Of course, there are certain limitations to the possibility of full retraction of the valve in a correct position.
In addition to the presented technique, 1 more repositioning technique is available (2). This is the “Removing and Repositioning” technique, which may be used in the case of too-high initial positioning of the prosthesis. However, it can be performed only if the prosthesis is still semi-deployed. In this procedure, the prosthesis is: 1) retrieved within the housing sheath; 2) removed from the body and inspected; and 3) re-inserted and successfully implanted.
In conclusion, it should be noted that the CoreValve (Medtronic) was not primarily designed to be repositioned and the manufacturer does not promote it, so the described repositioning techniques should be used as bail-out techniques.
- American College of Cardiology Foundation
- Latib A.,
- Michev I.,
- Laborde J.C.,
- Montorfano M.,
- Colombo A.
- Vavouranakis M.,
- Vrachatis D.A.,
- Toutouzas K.P.,
- Chrysohoou C.,
- Stefanadis C.