Transcatheter closure may be alternative solution of aortic anastomosis leak

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An aortic anastomosis leak (AAL) is a complication that’s difficult to address after surgery, but a case study from Chinese researchers offers a possible alternative to the usual method of handling this challenging issue—which is to operate.

The case study, concerning a 50-year-old woman who had aortic valve stenosis and ascending aortic dilation, was published online Aug. 30 in JACC: Cardiovascular Interventions.

“The AAL is a knotty complication after aortic surgery,” wrote Junzhou Pu, MD, with the interventional department at Beijing Anzhen Hospital, Capital Medical University, and colleagues. “Repeat operation, though it is an effective treatment, is associated with high morbidity and mortality rates. Transcatheter closure might be an alternative option for such intractable cases.”

Eight months prior to the intervention to address the leak, the patient had undergone a composite aortic valve and root replacement. Computed tomography angiography performed during follow-up revealed the presence of a 4-by-7-mm oval leak located at the distal anastomosis of the aortic prosthesis. In addition, an aorta-to-right atrium fistula was created by the patent Cabrol shunt through the leak.

For two months before the transcatheter closure, the woman had been experiencing symptoms of heart failure. At the time of the transcatheter closure, she had cardiac function of New York Heart Association (NYHA) functional class III.

The transcatheter closure of the aortic anastomosis leak was performed in the catheterization laboratory.

“Under the guidance of a 5-F JR 4.0 catheter, a 260-cm 0.035-inch guidewire was passed through the leak into the right atrium in a retrograde approach. The guidewire was then snared, establishing a femoral anteriovenous loop,” the team wrote.

In addition, considering the oval shape of the leak, a 14-by-5-mm Amplatzer Vascular Plug III (AGA Medical) was deployed coaxially to the leak. Subsequently, imaging showed that the AAL was well occluded.

After implantation of the occluder, the patient’s symptoms of dyspnea improved immediately. Only a trivial residual leak remained, and the patient’s cardiac function improved to NYHA functional class I.