Emergency TAVI using a no-contrast technique was successfully performed in a patient with severe bicuspid aortic stenosis complicated by cardiogenic shock and cardiorenal syndrome, resulting in clinical recovery.
Case Report (n=1)
No
Does emergency TAVI with a no-contrast technique improve outcomes in a patient with severe bicuspid aortic stenosis, cardiogenic shock, and cardiorenal syndrome?
Emergency TAVI using a no-contrast approach with TOE guidance is feasible and can be life-saving in patients with severe bicuspid aortic stenosis complicated by cardiogenic shock and cardiorenal syndrome.
A 78-year man with severe aortic stenosis awaiting elective surgical aortic valve replacement presented with worsening New York Heart Association IV shortness of breath. Despite appropriate heart failure treatment, he deteriorated and developed cardiogenic shock and cardiorenal syndrome which progressed despite inotropic support. A non-contrast-gated CT coronary angiogram was arranged in light of acute renal failure which revealed a bicuspid aortic valve. Three-dimensional transoesophageal echocardiography guidance was used to assist annulus sizing. An emergency transcatheter aortic valve replacement (eTAVI) was carried out 5 days into admission with a 34 mm Core Valve Evolut Pro valve with a no contrast technique. The patient's blood pressure and urine output improved and no procedural complications were encountered. He was discharged after 21 days and has remained well subsequently. This case highlights the utility of eTAVI and demonstrates the feasibility of a no contrast approach.
Byrne et al. (2021) conducted a case report in Severe bicuspid aortic stenosis with cardiogenic shock and cardiorenal syndrome (n=1). Emergency transcatheter aortic valve replacement (eTAVI) was evaluated on Procedural success and clinical recovery. Emergency TAVI using a no-contrast technique was successfully performed in a patient with severe bicuspid aortic stenosis complicated by cardiogenic shock and cardiorenal syndrome, resulting in clinical recovery.