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. 2022 May 2;34(5):936-938.
doi: 10.1093/icvts/ivac017.

Modified implantation of a Bolton Relay branch arch device into the ascending aorta close to a mechanical aortic valve

Artur Milnerowicz  1 , Tomasz Jędrzejczak  2 , Paweł Rynio  2 , Arkadiusz Kazimierczak  2
Affiliations

Modified implantation of a Bolton Relay branch arch device into the ascending aorta close to a mechanical aortic valve

Artur Milnerowicz et al. Interact Cardiovasc Thorac Surg. .

Abstract

An aortic arch stent graft is usually contraindicated with a mechanical aortic valve. However, a modified stent graft plus the use of an externalized transapical guidewire technique allowed a safe implantation close to a mechanical aortic valve.

Keywords: Artificial Aortic Valve; Branch Arch Device; Externalized Transapical Guidewire; Physician Modified Endograft.

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Figures

Figure 1:
Figure 1:
(A) 3-Dimensional reconstruction of the tomographic image. Expected position of a delivery system without tip modification. Sizing: P1–P2: space for the tip of the delivery system (29 mm); P2-P3: proximal sealing zone (34 mm); P3-P4: access to the branches (50 mm); P4-P5: distal sealing zone. (B) Completion angiographic scan: patent venous bypass; no endoleak.
Figure 2:
Figure 2:
(A) Red sketch on the fluoroscopic image shows space obtained after cutting 15 mm from the tip of the stent graft. The wire was guided by the 6 Fr sheath from the apex to keep it away from the disc hinge. (B) 3-Dimensional reconstruction of the tomographic image. Mechanism of the disc blockade if the valve is simply crossed. (C/D) Transoesophageal echocardiography. (C) Effective valve closure; green arrows show correct position of the wire. (D) Severe valve regurgitation after the blockade of the disc. Red arrow shows the position of the wire.
See this image and copyright information in PMC

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