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