[MP-24] Trans subclavian approach TAVI using Sapien3
Patient was 91 year old male, suffering from symptomatic severe AS (AVA0.73, mean PG52.1) with high operative risk (STS 8.2%). In MDCT findings, aortic annulus area was around 630 mm2, perimeter was 91.0 mm and mean diameter was 30.0 mm. Aortic root and femoral artery had ectasia but severe tortuous and Abdominal Aortic Aneurysm (AAA) was seen. Because Evolut-R was over-ranged from the CT perimeter sizing, we decided to perform TAVI using SAPIEN3 via left subclavian artery. At first, left subclavian artery was exposed surgically and built an artificial blood vessel. And then, e-sheath was inserted to ascending artery and pre ballooning was performed using 25mm. Finally, we deployed 29mm SAPIEN3 with nominal-2cc inflation volume. There was no severe para valvular leak and basal rupture, but aortagraphy showed dissection in anastomotic part of artificial blood vessel. Next, we put a self-expandable stent (SMART 10.0x80 mm) in ostium of subclavian artery to prevent an expansion of dissection to an aortic root. Operation was done with minimal complication at that time and went back to ICU after extubation. Post-operative day 2, he complained severe dyspnea and CT examination showed communicating aortic dissection from the bifurcation of subclavian artery to ostium of AAA. We continued intensive observation therapy because of no incidence of ascending dissection. 3 weeks later, he suddenly got CPA in hospital and died due to aortic rupture. We reported a complication TAVI case using SAPIEN3 via left subclavian artery.