Key result
CPB-supported transfemoral TAVI safely lowers mean aortic gradient to ~15 mm Hg alongside prior mitral prosthesis.
Why the study?
TAVI is rarely performed in patients with a pre-existing mitral valve prosthesis, an exclusion criterion in the Placement of Aortic Transcatheter Valve trial.
Does transcatheter aortic valve implantation using cardiopulmonary bypass allow for safe and successful treatment of severe aortic valve stenosis in a patient with a pre-existing mitral valve prosthesis?
Case Report (n=1)
No
Does transcatheter aortic valve implantation using cardiopulmonary bypass allow for safe and successful treatment of severe aortic valve stenosis in a patient with a pre-existing mitral valve prosthesis?
Answers are grounded in this paper and cite their sources.
TAVI utilizing cardiopulmonary bypass support appears to be a feasible and hemodynamically stable alternative for high-risk patients with severe aortic stenosis and a pre-existing mitral valve prosthesis.
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) is rarely performed in patients with a pre-existing mitral valve prosthesis, which was excluded from the Placement of Aortic Transcatheter Valve trial. Cardiopulmonary bypass (CPB) can provide sufficient hemodynamic stability to facilitate safe implantation; specifically, we prefer using normothermic femoro-femoral CPB. Careful attention should be paid to determine the positional relationship between the two valves in such patients. PRESENTATION OF CASE: We present a case of transfemoral TAVI using femoro-femoral CPB in a 90-year-old female patient with a pre-existing bioprosthetic mitral valve. Baseline echocardiography revealed severe aortic valve stenosis; hence, emergency balloon valvuloplasty was performed. Three months later, elective TAVI was performed; subsequently, left ventricular ejection fraction reached 63 % without mitral valve regurgitation or stenosis. DISCUSSION: Despite the safety of TAVI using CPB in older patients, cannula insertion into peripheral vessels carries a high risk. CONCLUSION: As CPB can increase tissue invasion for a short duration, the safety of this procedure needs further validation.
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Endo et al. (2023) conducted a case report in Severe aortic valve stenosis with pre-existing mitral valve prosthesis (n=1). Transcatheter aortic valve implantation (TAVI) using femoro-femoral cardiopulmonary bypass was evaluated on Procedural success and post-operative hemodynamic improvement. Transfemoral transcatheter aortic valve implantation using cardiopulmonary bypass was successfully performed in a 90-year-old patient with a pre-existing mitral valve prosthesis, decreasing the mean AV gradient to 15 mm Hg without complications.
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