Aortic Arch Mobile Thrombus in TAVR: the Direct Aortic Solution Basel Ramlawi,MD, MMSc, FACS, FACC, FRCSC Co-Director, Methodist Aortic Network Cardiothoracic Surgery & Transplantation Methodist DeBakey Heart Center The Methodist Hospital Houston, TX
Basel Ramlawi, MD Bramlawi@TMHS.ORG
Left Carotid Angiogaphy
M2 Cutoff
Flow Restored Basel Ramlawi, MD Bramlawi@TMHS.ORG
Angiogram Pre and Post Rescue
PRE
POST
Basel Ramlawi, MD Bramlawi@TMHS.ORG
MRI AT 24 Hours
Basel Ramlawi, MD Bramlawi@TMHS.ORG
Clot Retrieved from M2 After Hemiparesis Noted • Minor residual deficits • Walking in ICU next day… • … Prevention better option!
Basel Ramlawi, MD Bramlawi@TMHS.ORG
Case • • • •
82M with severe AS. Very poor lung function FEV1 <30% predicted Renal failure with HD EF 25%, previous stents, mild MR
• Accepted for TAVR. • Preoperative TEE in OR showed… Basel Ramlawi, MD Bramlawi@TMHS.ORG
Basel Ramlawi, MD Bramlawi@TMHS.ORG
Technical Considerations: Determine aortic access site is â&#x2030;Ľ6 cm from the annulus Assess location of the ascending aorta (midline/ant chest wall) Select access site to achieve a delivery trajectory that optimizes coaxial alignment with native aortic valve Assess calcification Identify critical vessels (esp location and course of patent LIMA or RIMA grafts) Basel Ramlawi, MD Bramlawi@TMHS.ORG
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Basel Ramlawi, MD Bramlawi@TMHS.ORG
Mini sternotomy vs Anterior mini thoracotomy
Basel Ramlawi, MD Bramlawi@TMHS.ORG
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Basel Ramlawi, MD Bramlawi@TMHS.ORG
Aortic Arch Mobile Thrombus in TAVR: the Direct Aortic Solution Basel Ramlawi,MD, MMSc, FACS, FACC, FRCSC Co-Director, Methodist Aortic Network Cardiothoracic Surgery & Transplantation Methodist DeBakey Heart Center The Methodist Hospital Houston, TX
Basel Ramlawi, MD Bramlawi@TMHS.ORG