Cannulation of the Femoral Arterial Bypass Cannula Allows Completion of TAVR in Unstable Patients

When hemodynamic instability occurs during transcatheter aortic valve replacement, peripheral cardiopulmonary bypass is required. The pigtail catheter, initially placed through the femoral artery to direct placement of the valve, is exchanged over a wire for an arterial bypass cannula. Other than time-consuming arterial cut-down procedures in hypotensive patients, there are few techniques described to allow the operator to continue bypass and complete transcatheter aortic valve replacement. This report describes a method to reintroduce the pigtail catheter by puncturing the arterial bypass cannula. This technique allows the operator to support the patient, continue bypass, and successfully place the valve without aborting the procedure.