First North American Experience With the Engager Self-Expanding Transcatheter Aortic Valve: Insights From the London Health Sciences Centre Heart Team

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Presentation transcript:

First North American Experience With the Engager Self-Expanding Transcatheter Aortic Valve: Insights From the London Health Sciences Centre Heart Team Rodrigo Bagur, MD, PhD, Bob Kiaii, MD, Patrick J. Teefy, MD, Pantelis Diamantouros, MD, Ronit Lavi, MD, Christopher Harle, MBChB, FRCA, Mauro Cassese, MD, Michael W.A. Chu, MD The Annals of Thoracic Surgery Volume 102, Issue 2, Pages e167-e171 (August 2016) DOI: 10.1016/j.athoracsur.2016.02.091 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Valve positioning. (A, B) The introducer tube is advanced 2 to 4 cm into the left ventricle until the retainer faces the end of the pigtail curl (thick arrow). Alignment is obtained looking at a small window located on the top of the valve commissure. The central commissural post is positioned posteriorly (circle and thin arrow) and the crimped control arms above the cusps (dashed arrows). The protruding surface of the retainer should always be toward the right side of the screen (brace) and the flat surface toward the left side of the screen (thick arrow). (C) Aortographic view showing the aortic cusps. Small windows of (B) adapted from Medtronic with permission (© Medtronic 2015). Angiographic images are from patients of this series. The Annals of Thoracic Surgery 2016 102, e167-e171DOI: (10.1016/j.athoracsur.2016.02.091) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Valve implantation. (A) Releasing the control arms. (B) Pulling the device and seating the control arms into the native aortic cusps. (C) A second view better depicts the position of the right control arm (dashed arrows) seating in the right coronary cusp of the native aortic valve, which is located anteriorly (center of screen). (D) Aortographic view confirming accurate position. Thin arrows depict the central commissural post, located posteriorly, and the pigtail catheter (white arrowhead) in the noncoronary cusp. Black arrowhead depicts the left coronary cusp. A and B adapted from Medtronic with permission (© Medtronic 2015). Angiographic images are from patients of this series. The Annals of Thoracic Surgery 2016 102, e167-e171DOI: (10.1016/j.athoracsur.2016.02.091) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Valve releasing and deployment. (A) Releasing the commissure posts. (B) Bioprosthesis self-deployment. (C) Retrieving the delivery system. (D) Engager valve at the end of the transapical aortic valve implantation. Thin arrow depicts the central commissural post, located posteriorly, and the pigtail catheter (white arrowhead) in the noncoronary cusp. Black arrowhead depicts the left coronary cusp. A and B adapted from Medtronic with permission (© Medtronic 2015). Angiographic images are from patients of this series. The Annals of Thoracic Surgery 2016 102, e167-e171DOI: (10.1016/j.athoracsur.2016.02.091) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions