Author + information
- Received July 28, 2015
- Accepted August 13, 2015
- Published online December 28, 2015.
- Keisuke Nakabayashi, MD∗∗ (, )
- Masaaki Koide, MD, PhD†,
- Hisayuki Okada, MD, PhD∗ and
- Toshiaki Oka, MD, PhD∗
- ∗Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
- †Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan
- ↵∗Reprint requests and correspondence:
Dr. Keisuke Nakabayashi, Department of Cardiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu City, Shizuoka 430-8558, Japan.
An 84-year-old woman with severe aortic stenosis presented for transapical transcatheter aortic valve replacement because her aorta was severely calcified and tortuous.
We inserted a 24-F sheath into the left ventricle and performed balloon aortic valvuloplasty with a 20-mm balloon under rapid pacing (Figure 1A). We then immediately deployed a 23-mm SAPIEN XT valve (Edwards Lifesciences, Irvine, California) (Figure 1B, Online Videos 1 and 2). As refractory ventricular fibrillation occurred, we cannulated the ascending aorta as an arterial line via the apical sheath through the bioprosthetic valve (Figure 1C, Online Video 3). Thereafter, we confirmed the intact right coronary artery (Figure 1D). Extracorporeal circulation (ECC) stabilized her hemodynamics, and electrical defibrillation was successful 25 min later. ECC was withdrawn after retrieving the apical sheath and confirming complete hemostasis (Figure 1E).
ECC can be used to stabilize a patient’s condition and to achieve hemodynamic stability during transcatheter aortic valve replacement, especially after rapid pacing (1). Transapical cannulation is the fastest and safest access in patients with a severe atherosclerotic aorta (2).
For supplemental videos and their legends, please see the online version of this article.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 28, 2015.
- Accepted August 13, 2015.
- American College of Cardiology Foundation