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Positionnement de la valve

Positionnement de la valve. Dominique Himbert Hôpital Bichat, AP-HP. The « Check List ». Hemodynamic condition Quality of pacing Position of the guide wire in the apex of LV Perpendicularity to the aortic plane Positioning Deployment. « The 3 Cusps View ». C-THV Perpendicular View.

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Positionnement de la valve

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  1. Positionnement de la valve Dominique Himbert Hôpital Bichat, AP-HP

  2. The « Check List » • Hemodynamic condition • Quality of pacing • Position of the guide wire in the apex of LV • Perpendicularity to the aortic plane • Positioning • Deployment

  3. « The 3 Cusps View »

  4. C-THVPerpendicular View + =

  5. Segmented Dyna CT

  6. The « Check List » • Hemodynamic condition • Quality of pacing • Position of the guide wire in the apex of LV • Perpendicularity to the aortic plane • Positioning • Deployment

  7. Final Positioning ES

  8. Rapid pacing to Help Positioning

  9. Search for a Good Alignment

  10. C-THV Positioning

  11. C-THV RT Positioning

  12. CT overlay on live fluoroscopy

  13. 2D TEE Guidance

  14. 3D TEE Guidance

  15. ICE Guidance

  16. The « Check List » • Hemodynamic condition • Quality of pacing • Position of the guide wire in the apex of LV • Perpendicularity to the aortic plane • Positioning • Deployment

  17. Pacing Protocol for Valve Deployment

  18. Deployment of ES Prosthesis

  19. Angiography during Deployment of ES Prosthesis

  20. Slow Deployment for « Valve in a Valve »

  21. Final Result

  22. 3D TEE During Deployment

  23. Conclusions The « Key to Success » is to have a well structured team who follow these steps • Hemodynamic condition • Quality of pacing • Position of the guide wire in the apex of LV • Perpendicularity to the aortic plane • Positioning • Deployment

  24. Thank you!

  25. Percutaneous Aortic Valve ImplantationPacing of the right ventricle (200/min) Cribier et al J Am Coll Cardiol 2006; 47: 1216

  26. Rapid Ventricular Pacing 1:1 capture, SBP of 50 mmHg or below , and pulse pressure < 10 mmHg.

  27. New Systems for Navigation and Positioning during TAVI

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