Elsevier

Canadian Journal of Cardiology

Volume 36, Issue 12, December 2020, Pages 1977.e13-1977.e15
Canadian Journal of Cardiology

Case Report
A Case of TAVR Complicated by Severe Functional Mitral Regurgitation

https://doi.org/10.1016/j.cjca.2020.07.238Get rights and content

Abstract

Mitral regurgitation (MR) is a known complication of transcatheter aortic valve replacement (TAVR). We report a case of a 90-year-old man with severe symptomatic aortic stenosis who underwent elective TAVR. The procedure was complicated by severe functional MR from left ventricular stunning and dilatation caused by hypotension throughout the procedure. An Impella CP (Abiomed, Inc, Danvers, MA) was inserted to unload the left ventricle and decrease its size with subsequent improvement in MR severity, which was sustained after Impella CP removal. In conclusion, we present the first case of successful management of post-TAVR severe functional MR with an Impella CP.

Résumé

L'insuffisance mitrale (IM) est une complication connue du remplacement valvulaire aortique par cathéter (RVAC). Nous exposons le cas d’un homme de 90 ans présentant une sténose de l’aorte symptomatique grave ayant subi une ITVA non urgente. L’intervention a été compliquée par une IM fonctionnelle grave résultant d’une sidération et d’une dilatation du ventricule gauche, causées par l’hypotension durant l’intervention. Nous avons utilisé une pompe Impella CP (Abiomed, Inc, Danvers, MA) pour décharger le ventricule gauche et en réduire le volume afin d’atténuer l’intensité de l'IM, une amélioration qui s’est maintenue après le retrait du dispositif. En conclusion, nous présentons le tout premier cas de prise en charge fructueuse d’une RM fonctionnelle grave survenue après un RVAC grâce à une pompe Impella CP.

Section snippets

Case

A 90-year-old man with New York Heart Association class II heart failure from severe aortic stenosis was admitted for elective TAVR. His medical history included coronary artery disease, and paroxysmal atrial fibrillation. Transthoracic echocardiogram had shown severe calcified aortic stenosis (peak velocity: 4.5 m/s, mean gradient: 51 mm Hg, aortic valve area: 0.8 cm2), 70% left ventricular ejection fraction, concentric left ventricular hypertrophy, and mild MR. In the weeks preceding TAVR, he

Discussion

Impella CP has previously been used as a rescue therapy for cardiogenic shock complicating TAVR, caused by 1 of the following: low output failure during implantation, coronary obstruction, refractory ventricular tachycardia, severe PVL, and annular rupture. Thirty-day mortality was 40%.3 Other mechanical circulatory support options including intra-aortic balloon pump, Tandem Heart (CardiacAssist, Inc, Pittsburgh, PA) and extracorporeal membrane oxygenation have also been reported. Of those,

Funding Sources

The authors report no funding sources.

Disclosures

The authors have no conflicts of interest to disclose.

References (5)

  • A. Morello et al.

    Complications after transcatheter aortic valve implantation: an updated umbrella review

    Curr Emerg Hosp Med Rep

    (2019)
  • J. Lopez-Aguilera et al.

    Mitral regurgitation during transcatheter aortic valve implantation: the same complication with a different mechanism

    J Invasive Cardiol

    (2014)
There are more references available in the full text version of this article.

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