Emergency Treatment of Acute Decompensated Critical Aortic Stenosis With Transcatheter Aortic Valve Implantation

Abstract

Transcatheter aortic valve implantation (TAVI) is relatively contraindicated in the bicuspid aortic valve, and to our knowledge has not been tried where the true native annulus is of a size far in excess of current device capabilities. We present here a case of a successful emergency TAVI of a 73-year-old previously healthy man, who presented with cardiogenic shock, ventricular tachycardia storm and severe left ventricular dysfunction because of the underlying critical bicuspid aortic stenosis with aortic annulus area of 991.9 mm² and associated moderate aortic incompetence (the Society of Thoracic Surgeons (STS) risk score; score mortality of 40.9%). Despite the critical condition of the patient and technically challenging anatomy, successful TAVI was performed and the patient remains well with near-normal left ventricle (LV) function at 6 months follow-up.

Keywords:

• cardiac arrest
• cardiogenic shock
• decompensated severe aortic stenosis
• emergency TAVR
• large annulus
• transcatheter aortic valve implantation

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at:www.tandfonline.com/doi/full/10.2217/fca-2020-0092

Author contributions

The primary author, K Singh was the first operator for the case and have a significant contribution on the case write up. KTH Win was corresponding author and coauthor for the case and helped with literature search and write up on the case. A Camuglia was coauthor for the case and was also involved in decision making prior and during the procedure. S Provenzano was also a coauthor for the case and was a second operator for the case and involved in the case write up.

Financial & competing interests disclosure

K Singh has received research funding, lecture and consulting fee from Terumo, Bayer, AstraZeneca and BMS. A Camuglia is a clinical proctor for Abbott and has also received research funding and consulting fees from Abbott. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained verbal informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.

Additional information

Funding

K Singh has received research funding, lecture and consulting fee from Terumo, Bayer, AstraZeneca and BMS. A Camuglia is a clinical proctor for Abbott and has also received research funding and consulting fees from Abbott. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.