A novel pigtail/J-wire technique for crossing stenotic aortic valves (AV) was found to be rapid, simple, and safe to implement, according to a prospective study, published in Clinical Research in Cardiology.

A total of 100 patients with severe symptomatic aortic stenosis were recruited at the Duisberg Heart Center in Germany. Participants had AV areas £1 cm2 or indexed AV area £0.6 cm2/m2 and were receiving transcatheter AV implantation (TAVI). All patients had a standardized attempt at crossing the AV with this novel pigtail/J-wire technique within 5 minutes. If a failure occurred, a conventional Amplatz/straight wire approach was implemented.

The pigtail/J-wire approach consists of a 5 F electrode catheter placed in the right ventricular apex by way of either side femoral vein and a 5 F pigtail catheter for dye injection positioned in the ascending aorta by way of the properly sided femoral artery. With an appropriately sized sheath, a pigtail catheter on a J-wire was inserted in the ascending aorta 3 to 4 cm above the valvular plane in the right anterior oblique view. When the J-wire was pushed out, a u-shaped curve above the aortic valve was formed allowing for AV crossing.

Successful AV crossing was observed within 5 minutes in 86% of participants. Patients who had unsuccessful vs successful AV crossing with this approach differed significantly at baseline in: age (79.4 vs 84.1 years, respectively; P <.001), height (1.74 vs 1.69 m, respectively; P =.01), and Society of thoracic surgery score (2.87 vs 4.3, respectively 5; P <.001), but not in echocardiographic parameters.


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Among patients in which the pigtail/J-wire technique was successful, the median time was 30 seconds (range, 2-298 seconds). The success rate increased from 82.5% for the first 40 procedures to 86.6% for the next 30, and 90% for the final 30 procedures.

The investigators observed that, in general, if the pigtail/J-wire technique was unsuccessful within the first 2 minutes, failure was likely. Among patients who had a failed attempt with the pigtail/J-wire technique, the Amplatz left/straight technique was successful (Amplatz left-1 curve, n=6; Amplatz left-1 and Amplatz left-2 curves, n=8).

No hemopericardia events, coronary events, or neurological symptoms were observed in any of the participants.

A potential limitation of this study is that the participating clinicians had prior experience using the pigtail/J-wire approach, and as success rates increased with clinician experience, the observed high success rate may not be reproducible among clinicians with no prior experience.

“[The pigtail/J-wire approach] does not require sophisticated material and it clearly works, as proven by the data presented here,” concluded the study authors.

Reference

Schoels W, Mahmoud M S, Kullmer M, et al. A safe and simple technique for crossing stenotic aortic valves. [published online September 19, 2020] Clin Res Cardiol. doi:10.1007/s00392-020-01744-4