Author + information
- Robert J. Lederman, MD∗∗ (, )
- Marcus Y. Chen, MD∗,
- Toby Rogers, MD∗,
- Dee Dee Wang, MD†,
- Gaetano Paone, MD†,
- Mayra Guerrero, MD†,
- William W. O’Neill, MD† and
- Adam B. Greenbaum, MD†
- ∗Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
- †Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan
- ↵∗Reprint requests and correspondence:
Dr. Robert J. Lederman, Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, Maryland 20892-1538.
- cardiac catheterization
- extra-anatomic procedures
- medical devices
- transcatheter valve replacement
- vascular access and closure
Transcaval (“caval-aortic”) access is a new approach to introduce large devices, such as transcatheter aortic valves, into the abdominal aorta in patients who otherwise lack access options. In this technique, coaxial catheters are introduced into the body from the femoral vein, and advanced into the abdominal aorta from the adjoining inferior vena cava under fluoroscopic guidance. The aorto-caval fistula is closed using a nitinol cardiac occluder device after the therapeutic procedure (1). After systematic image analysis (Figures 1 to 6⇓⇓⇓⇓⇓), we provide favorability recommendations. “Unfavorable” indicates that transcaval access is not recommended. “Feasible” suggests elevated risk over a favorable classification (Table 1).
The authors thank Janet F. Wyman and Christina Nelson at the Henry Ford Health System.
For an accompanying video and legend, please see the online version of this article.
This work was supported by the Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health (grants #Z01-HL005062 and #Z01-HL006040 to Dr. Lederman). Drs. Lederman, Rogers, and Greenbaum are inventors on patent applications, assigned to the National Institutes of Health and the Henry Ford Health System, respectively, on devices for transcaval access and closure. Dr. Guerrero receives consulting fees from Edwards Lifesciences. Dr. O’Neill receives consulting fees from Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation