CoreValve deployment during cardiopulmonary resuscitation without angiographic injections guidance: An additional capability of Accutrak system?

Abstract

Transcatheter aortic valve implantation (TAVI) has become an accepted treatment option for high-risk patients with symptomatic severe aortic stenosis (AS), for whom conventional surgical replacement has been previously denied [1,2]. TAVI is a technically demanding procedure, which sometimes may be accompanied by dreadful complications [3]. The accurate prosthesis positioning is of major significance for the success of the procedure and is performed under continuous fluoroscopy guidance. The previous CoreValve (Medtronic, Inc) device has been criticized for the tendency to advance during deployment. The new Accutrak stability layer of the delivery catheter system is promoted to ensure stability during the procedure. We report a case of CoreValve prosthesis deployment during Cardiopulmonary Resuscitation (CPR) without angiographic injections guidance, with the new Accutrak stability layer. An 81-year old female presented to our hospital suffering from shortness of breath on exertion and fatigue in ordinary physical activity (New York Heart Association functional classification class III). She had a medical history of extracardiac arteriopathy. The transthoracic echocardiogram was diagnostic for severe aortic valve stenosis revealing severe calcification of the valve, mean gradient 42 mm Hg,