EXTRAORDINARY TAVR IN A HEAVILY CALCIFIED BICUSPID AV WITH HORIZONTAL ROOT AND SEVERELY TORTUOUS AORTA USING NOVEL PYTHON BZ INTRODUCER

EXTRAORDINARY TAVR IN A HEAVILY CALCIFIED BICUSPID AV WITH HORIZONTAL ROOT AND SEVERELY TORTUOUS AORTA USING NOVEL PYTHON BZ INTRODUCER
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CASE:

83-year-old male

Admitted with Acute Heart Failure Syndrome

Past history of DM / HTN / TIA and COPD

No previous significant past surgical history

Echo: Severe Aortic stenosis with severe LV dysfunction (EF 20%) and moderate PAH

Coronaries: Moderate CAD

CT TAVR protocol was done

CT TAVR: Heavily calcified Bicuspid AV (FIGURE 1) with severely tortuous aorta  (FIGURE-2)

FIGURE: 1                          FIGURE: 2

To navigate through this tortuosity we used a novel Python BZ smart Introducer Sheath

  • Python BZsmart Introducer Sheath has been co-developed with Prof. Bharat Dalvi, India and Prof. Ziyad Hijazi, USA. (B for Bharat & Z for Ziyad).
  • Python BZ is modeled on extra large ⌀24 Fr & extra long 76.5cm .
  • The patented short tip dilator in Python BZhas 3 guide wire exit ports to simultaneously accommodate multiple 0.035″ guide wires which may be parked across right and left pulmonary arteries for improved support during tracking of the long introducer sheath.
  • The 24 Fr dilator and distal introducer segments have higher flexibility & allow for smooth navigation across the tortuous anatomy
  • An undeployed Myval THV may be fully retrieved from the Python BZ  smart in case of inability to cross the native valve.

PYTHON BZ XL SHEATH DELIVERY

VALVE DELIVERY THROUGH THE SHEATH AND DEPLOYED

FINAL OCTAPRO POSITION WITH MINIMAL FORESHORTENING

TAKE HOME MESSAGE

  • Myval Octapro with the unique design characteristics and minimal foreshortening gives a predictable TAVR deployment in a complex anatomy
  • Recent RCT’s support the use of Myval platform in majority of our aortic stenotic cases, as it is proven non-inferior and, in some aspects, superior hemodynamics with less Patient Prosthesis Mismatch
  • The unique feature of the Python BZ sheath with triple lumen access provides an additional safer femoral option in complex tortuous aortic anatomies as shown in this case before changing to alternate access

 

Dr. Kamal Kant Jena
Associate Consultant- Interventional Cardiology
Kauvery Hospital, Chennai

 

 

Dr Rajaram Anantharaman
Director for Transcatheter Heart Valve Therapies
Lead for Advanced Heart Failure, Cardiomyopathy, Circulatory Support and Transplantation (ACCiST Centre)
Kauvery Hospital, Chennai