A novel Self-Centering Guide Catheter (SCGC) used during transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS) shows no safety concerns and successfully operates during TAVR, a first-in-human study shows. This was reported by Mackram F. Eleid, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues, in a research letter published Wednesday online in JACC: Cardiovascular Interventions. The most common treatment for AS is TAVR. During TAVR, retrograde crossing of the stenotic aortic valve (AV) presents a challenge. Usually, this procedure is performed with a coronary diagnostic catheter, but this creates an elevated risk for cerebral embolism. The investigators in this study examined the safety and efficacy of a novel SCGC (Boston Scientific), used for guiding the catheter wire across the stenotic AV orifice by aligning itself with the high velocity AS blood flow stream. A total of 20 patients (mean age=78 years, 45% female) with severe AS undergoing transfemoral TAVR were included in this single-center, prospective, open-label, first-in-human study. TAVR devices included in the study were the SAPIEN 3 valve (Edwards Lifesciences) and Evolut R (Medtronic). Of the patients, 19 had tricuspid AS and 1 had bicuspid AS, and a total of 23 SCGC devices were used in the 20 procedures. Successful delivery of the guidewire through the SCGC across the AV into the left ventricle (LV) occurred in 18 of 20 patients, and in 43.5% of SCGC devices, the AV was crossed with a guidewire in 1 to 3 attempts. TAVR was performed successfully in all patients. The average time from insertion of the SCGC to removal from the body was 6.6 minutes, and it took an average of 3.8 minutes from the insertion of the SCGC into the body to the placement of the guidewire across the AV. No adverse events, including stroke, mortality or cardiac tamponade, were observed throughout the 30-day study period. This small study highlighted the potential of the purpose-built catheter for retrograde AV crossing during TAVR. Overall, the investigators observed no safety incidents during the trial period and successfully completed TAVR in all 20 patients in the study. Source: Eleid MF, Gulati R, Tefft BJ, et al. A Novel Self-Centering Aortic Valve Crossing Catheter for Transcatheter Aortic Valve Replacement. JACC: Cardiovasc Interv. 2025 Feb 19 (Article in Press). Image Credit: mehmet – stock.adobe.com