Emergent Transcatheter Aortic Valve Implantation as a Life-saving Procedure: A Primary Treatment Approach

Severe aortic stenosis (SAS) is the most common valvular heart disease in elderly patients. Untreated SAS is known to have 50% mortality within 2 years of onset of symptoms. SAS with acute decompensated heart failure is fatal and requires immediate, appropriate treatment. Urgent transcatheter aortic valve implantation (TAVI) is acceptable with feasible outcomes for a selected group of patients with decompensated SAS. Herein, we present a case of a primary TAVI procedure with a good outcome for decompensated SAS. The patient was an 85-year female with SAS with peak/mean transvalvular gradients of 73/42 mmHg, and left ventricular ejection fraction (LVEF) of 60% on echocardiography. The TAVI procedure was confirmed with echocardiography and angiography. As there was no anatomic contraindication for TAVI, primary TAVI was selected for this patient with implantation of a No. 29 Portico™ TAVI valve (Abbott; St. Jude Medical Inc., St. Paul, MN, USA). To the best of the authors' knowledge, this case is the first to be reported as primary TAVI which was performed in 4 hours of emergency situation. A life-saving procedure was performed, which lasted 4 hours from door-tovalve placement.