Endo Y, Nakanowatari H, Kitagawa A, Fukada Y, Irie Y. Transcatheter aortic valve implantation with pre-existing mitral valve prosthesis using cardiopulmonary bypass: A case report.
Int J Surg Case Rep 2023;
109:108559. [PMID:
37524019 PMCID:
PMC10400854 DOI:
10.1016/j.ijscr.2023.108559]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023] Open
Abstract
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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