Presenter: Yoshiaki Katada

Affiliation: Iwaki City Medical Center, Japan; Tokyo Medical University Ibaraki Medical Center, Japan

Abstract

This study evaluates the mid-term outcomes of transcatheter plug closure (AVP2) for LVOT pseudoaneurysms following aortic valve and root surgery. Three high-risk patients (EuroScore 1.92-9.65) achieved complete aneurysm closure with no device migration or cardiac dysfunction at 4.5-year follow-up. Technical success rate was 100%, with one perioperative stroke-related mortality (7.1%). AVP2 occlusion is a safe and effective minimally invasive option for wide-neck LVOT pseudoaneurysms.

Introduction

LVOT pseudoaneurysms are rare but life-threatening complications post-cardiac surgery. Transcatheter closure offers a less invasive alternative to open repair, particularly for high-risk patients. This study details technical strategies and outcomes in three complex cases.

Case Study

Case 1: A 74-year-old female with IE underwent AVR and redo-AVR. 

Preoperative CT revealed an 8.5mm-neck pseudoaneurysm. 

AVP2 10mm was deployed via femoral access. 

Follow-up at 4.5 years showed sustained closure.

Case 2: A 65-year-old male post-Bentall procedure presented with a 3.2mm-neck aneurysm. 

Transapical AVP2 12mm achieved complete sealing, confirmed at 2.5-year imaging.

Case 3: A 74-year-old female post-Bentall+MAP developed a 2.5mm-neck aneurysm. 

Transarterial AVP2 8mm deployment resulted in thrombosis at 42 days, with no recurrence at 3 years.

Conclusions

1.AVP2 for Wide Necks: The triple-layered mesh design ensures stability in large defects (≥8mm), avoiding coil migration risks.

2.Dual Access Feasibility: Both transarterial and transapical approaches are viable, tailored to anatomical constraints.

3.Mandatory Anticoagulation: Long-term anticoagulation (e.g., warfarin) is critical to prevent thrombotic events, especially in atrial fibrillation.