Percutaneous TAVR devices are bioprosthetic valves mounted in nitinol stents. The valves are delivered by retrograde (eg, femoral or axillary artery) or antegrade (transapical) approaches. The latter requires mini-thoracotomy. TTE or TEE is used to confirm valve pathology prior to device placement, and echocardiographic and fluoroscopic guidance is used to ensure proper positioning during the procedure.

After venous and arterial access is obtained, a curve-tipped pigtail catheter for aortography is placed into the proximal aorta. This is followed by a straight wire across the AV, which is then exchanged for a soft-tipped rigid wire stabilized against the LV wall. The valve and deployment apparatus are advanced over this rigid wire. Balloon valvuloplasty might be required prior to valve deployment. During deployment, rapid ventricular pacing is used to decrease cardiac motion and minimize ejection pressure. Acute hypotension during valve deployment is typically followed by marked hypertension due to relief of AV stenotic obstruction.

References

• Boskovski MT, Gleason TG. Current therapeutic options in aortic stenosis. Circ Res. 2021;128:1398-1417.