Snare catheter technique in complex transcatheter aortic valve implantation procedures.

Background: Transcatheter aortic valve implantation is challenged by the anatomy and calcification of the arteries, aortic arch and aortic valve.

Aim: To describe successful complex transcatheter aortic valve implantation with the use of a snare catheter, where other standard techniques have failed.

Methods: From the database of 660 transcatheter aortic valve implantation procedures performed at the Clermont-Ferrand University Hospital between 01 February 2023 and 31 August 2024, we report the use of a snare catheter in five complex procedures with transcatheter heart valve advancement failure: two cases of failure to cross the aortic arch with a self-expandable transcatheter heart valve using standard techniques; one case of a horizontal aorta with failed advancement of a self-expandable transcatheter heart valve; a challenging case with significant calcification in the right coronary cusp impeding balloon-expandable transcatheter heart valve progression and crossing the native aortic valve; and another challenging case where the frame of an aortic bioprosthesis prevented the advancement of a self-expandable transcatheter heart valve.

Results: During all these procedures, the use of a snare catheter enabled the challenges of advancement to be overcome, whether within the aortic arch or a horizontal aorta, or when there were difficulties in crossing a native aortic valve or a bioprosthetic aortic valve, thereby allowing the successful implantation of the transcatheter heart valve.

Conclusions: The snare catheter strategy is an effective option for performing complex transcatheter aortic valve implantation procedures, specifically when crossing the aortic arch, a horizontal aorta, the aortic valve or an aortic bioprosthesis, and it is possible to use this technique while using the same access site for self-expandable transcatheter heart valve implantation.