Abstract
Successful use of percutaneous ECMO and intra-aortic balloon support for a rescue valve in valve TAVR procedure in a patient in cardiogenic shock
Highlights
Transcatheter aortic valve replacement (TAVR) is an effective method for treating severe aortic stenosis in high risk surgical patients that is recently being expanded to intermediate-risk populations [1,2,3]
Data is emerging on increased VA extracorporeal membrane oxygenation (ECMO) weaning success and increased survival when ECMO is used in combination with intra-aortic balloon pump (IABP) in patients with cardiogenic shock [6]
We report a case of a patient in cardiogenic shock due to left ventricular failure because of a severe redo biological AVR stenosis that was successfully treated with a rescue valve in valve TAVR under prophylactic pre- and postprocedural percutaneous mechanical support with a combination of VA ECMO and IABP
Summary
Transcatheter aortic valve replacement (TAVR) is an effective method for treating severe aortic stenosis in high risk surgical patients that is recently being expanded to intermediate-risk populations [1,2,3]. We report a case of a patient in cardiogenic shock due to left ventricular failure because of a severe redo biological AVR stenosis that was successfully treated with a rescue valve in valve TAVR under prophylactic pre- and postprocedural percutaneous mechanical support with a combination of VA ECMO and IABP. Echocardiography post procedurally revealed an improvement in LVEF to 30% with a good functioning of positioned aortic valve with a mean transprothetic gradient of 17 mmHg, AVA 2.5 cm, and mild pulmonary hypertension (sPAP 28 mm Hg). His latest echocardiography showed a dilated left ventricle (EDD 5.8 cm) with moderately decreased ejection fraction (LVEF 46%), good functioning of prosthetic valve (mean transprothetic gradient 20 mmHg, AVA 2.01 cm, minimal paravalvular leak) and mild pulmonary hypertension (sPAP 29 mmHg) (Figure. 3)
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