Transient Increase in Pressure Gradients After Termination of Dual Antiplatelet Therapy in a Patient After Transfemoral Aortic Valve Implantation

Abstract

Transcatheter aortic valve implantation (TAVI) is considered a transformational novel technology for the treatment of severe symptomatic aortic valve stenosis. It has been rapidly adopted in the clinical arena and meanwhile evolved to the standard of care for inoperable and an acceptable alternative for high-risk but operable patients.1,2 In analogy to surgical bioprosthetic aortic valve replacement, anticoagulation with vitamin K antagonists is not deemed necessary after TAVI. However, dual antiplatelet therapy with acetylsalicylic acid and clopidogrel is recommended for 6 months2 after the procedure, although this treatment regimen is not supported by any scientific evidence. A 72-year-old man with severe symptomatic aortic valve stenosis (aortic valve area, 0.9 cm2; mean transaortic gradient, 42 mm Hg; New York Heart Association [NYHA] functional class III; chronic kidney disease; logistic EuroSCORE, 19.8%; Society of Thoracic Surgeons score, 5.4%) underwent uncomplicated transfemoral TAVI using the balloon-expandable Edwards-Sapien bioprosthesis (Edwards Lifesciences Inc, Irvine, CA), which resulted in immediate hemodynamic and clinical improvement, especially in view …