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. 2021 Mar;16(1):227-233.
doi: 10.5114/wiitm.2020.93987. Epub 2020 Mar 27.

Externalized transapical guidewire technique after artificial aortic valve replacement during complete endovascular aortic arch repair

Tomasz Jędrzejczak  1 , Paweł Rynio  2 , Maciej Lewandowski  1 , Arkadiusz Kazimierczak  2
Affiliations

Externalized transapical guidewire technique after artificial aortic valve replacement during complete endovascular aortic arch repair

Tomasz Jędrzejczak et al. Wideochir Inne Tech Maloinwazyjne. 2021 Mar.

Abstract

An externalized transapical guidewire (ETAG) technique has been used for safe delivery of high-profile devices through a tortuous aorta to zone 0, which is currently precluded after mechanical artificial aortic valve replacement (AVR). The aim of the study was to report one center's experience (based on 3 cases) of a unique modification to the ETAG technique used for the first time during total endovascular aortic arch repair after AVR. This report contains technical notes regarding a new method of steering the guidewire from the apex inside the artificial aortic valve during total endovascular aortic arch repair after AVR and the details crucial in preparation for this mini-invasive procedure. As a conclusion, the ETAG technique could be performed after mechanical AVR with active positioning of the guidewire carried out under the control of transesophageal echocardiography.

Keywords: artificial aortic valve replacement; externalized transapical guidewire technique; physician-modified endograft; thoracic endovascular aortic repair.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Photo 1
Photo 1
Computed tomography angiography imaging. A – Before. Green arrow indicates the position of the artificial aortic valve. Yellow arrows show a hematoma and pseudoaneurysm in the ascending aorta. Red arrow indicates the collapsed true lumen. B – After. Green arrow indicates the position of the artificial aortic valve. Yellow arrows show the shrunken hematoma in the ascending aorta. Red arrow indicates the fully expanded true lumen
Photo 2
Photo 2
Bench test and graft modification. A – Sharp angulation of the ascending aorta after previous surgery. Blue arrow shows the direction of the tip of the stent graft towards the pseudoaneurysm. B – Mobility (red arrow) of the soft Terumo guidewire inside the ring of the artificial aortic valve. C – Steering of the position of the wire by the 12 F vascular port (working as a lever – red arrow) from the apex (working as the fulcrum of the lever – blue arrows). D – Schedule for the procedure. E – Stent graft modification (blue arrow shows the position of the left subclavian artery (LSA) fenestration, red arrows indicate double longitudinal ties). F – Further stent graft modification with pre-cannulation of the LSA fenestration (yellow arrow), shortening of the tip of the introduction system (green arrow), position of the LSA fenestration (blue arrow)
Photo 3
Photo 3
Guidewire position in the ring of the artificial aortic valve and the function of the valve. A – Guidewire (red arrow) in the center of the incompetent valve (valve blockade). B – Guidewire (red arrow) close to the hinge of the valve (incompetent valve function). C – Optimal position of the guidewire (green arrow) in the valve ring (competent valve)
Photo 4
Photo 4
This figure shows good graft function after surgery
See this image and copyright information in PMC

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