Multi-Pigtail Technique is Associated with Decreased Contrast Use and Fluoroscopic Adjustment for Transcatheter Aortic Valve Replacement

Maia L. Eng, Sarah A. Chen, Garima Agrawal, Jeffrey A. Southard, Thomas W.R. Smith, Garrett B. Wong, Walter D Boyd, Reginald I. Low, Gagan D. Singh

Research output: Contribution to journalArticlepeer-review


Background: Successful TAVR is partly determined by deploying the valve in the perpendicular angle of deployment (PAOD), which is in a 90-degree plane to the aortic annulus. Preprocedurally, the PAOD is predicted with multi-detector-computed tomography (MDCT). Intra-procedurally, one or more pigtail catheters are placed in the aortic annulus and an aortogram is used to corroborate the predicted PAOD. However, this often shows a non-PAOD necessitating fluoroscopic adjustments. We compared outcomes in patients undergoing TAVR with a one-pigtail (OP) or multi-pigtail (MP) technique. Methods: 283 TAVR patients were retrospectively analyzed from 2015 to 2017. 42% (n = 118) of the patients underwent an OP technique and 58% (n = 165) used an MP technique. We reviewed demographics, procedural characteristics, and major adverse cardiovascular events (MACE). Results: Patients in the MP group had decreased fluoroscopy time, contrast dose, and time to valve deployment (17.8 ± 8.7 vs 23.5 ± 13.6 20 min, p = 0.0000; 74.8 ± 39.8 vs 117.3 ± 59 cc, p = 0.0000; and 22.6 ± 9.4 vs 27.1 ± 13.1 min, p = 0.0011, respectively). There was no difference in MACE. Using multivariate linear regression with adjustment for differing baseline characteristics, MP use was independently associated with reduced contrast volume (ß –34; 95% CI –50 to –18; p = 0.001) and fluoroscopy time (ß –4.4; 95% CI –8.0 to –0.6; p = 0.022). Conclusions: In this single center retrospective study, use of an MP technique was associated with significantly decreased time to deployment, fluoroscopy time, and contrast dose in patients undergoing TAVR.

Original languageEnglish (US)
Pages (from-to)131-138
Number of pages8
JournalStructural Heart
Issue number2
StatePublished - Mar 3 2020


  • Aortic stenosis
  • aortic valve disease
  • TAVR
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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