Transcatheter aortic valve replacement performed via left ventricular assist device inflow cannula.

Abstract

A 62-year-old woman with a history of lung cancer, prior surgical aortic valve replacement with a 23-mm Hancock (Medtronic, Inc, Minneapolis, MN) porcine valve, and nonischemic cardiomyopathy supported with a HeartMate II destination therapy left ventricular assist device (LVAD; Thoratec Corporation, Pleasanton, CA) presented with hemolytic anemia (hemoglobin, 6.8 g/dL; lactate dehydrogenase, 1536 U/L) because of LVAD thrombosis and severe insufficiency of the 23-mm Hancock bioprosthetic valve (Figure 1; Movie I in the Data Supplement). Given her comorbidities and multiple prior sternotomies, she was felt to be a poor candidate for combined redo-surgical aortic valve and LVAD replacement via another sternotomy. Peripheral vascular disease precluded transfemoral transcatheter aortic valve replacement (TAVR). Therefore, it was decided that she would be best treated with concomitant LVAD pump exchange and TAVR via a transapical approach using the existing LVAD inflow cannula for access. Figure 1. Intraoperative aortogram showing severe bioprosthetic aortic valve insufficiency. Note the Coda occlusion balloon in the left ventricular assist device (LVAD) outflow cannula (*), LVAD inflow cannula (**) through which the Amplatz Extra Stiff wire can be seen traversing the porcine aortic valve, percutaneous venous cardiopulmonary bypass cannula (arrow), and temporary transvenous pacemaker in the right ventricle (arrowhead). A 5-cm incision was made below the lateral two thirds of the right clavicle to access the right axillary artery, and a 6-mm Dacron …