Trans catheter aortic valve implantation with core valve revalving system in uncoiled (horizontal) aorta. Overcoming anatomical and technical challenges for successful deployment

Uncoiling of the aortic root (horizontal aorta) offers a considerable technical challenge in successful deployment of core valve prosthesis. The problem is compounded in the presence of significant calcification of the ascending aorta that limits the capability to control the tension on delivery catheter during device release and may lead to implant failure. Recognition of adverse anatomical features and use of proximal access sites such as subclavian artery are likely to attenuate the degree of technical difficulty in these cases. Familiarity and facility with retrieval techniques using a snare catheter is desirable in cases of implant failure