© 2014 Wiley Periodicals, Inc.
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SURGICAL TECHNIQUE ___________________________________________________________
Carotid-Access Transcatheter Aortic Valve Replacement in a Patient with a Previous Mitral Valve Replacement Michael J. Daly, M.B.B.Ch., M.R.C.P.,* Paul H. Blair, M.D., F.R.C.S.,* Thomas Modine, M.D.,y Patrick M. Donnelly, M.D., F.R.C.P.,z Reuben Jeganathan, M.D., F.R.C.S. (C.Th.),* Ganesh Manoharan, M.D., F.R.C.P.,* and Mark S. Spence, M.D., F.R.C.P.* *The Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom; yHeart Team, Lille University Hospital, Lille, France; and zThe Ulster Hospital, Dundonald, Belfast, United Kingdom ABSTRACT We describe a case of transcatheter aortic valve replacement (TAVR) using carotid artery access and regional anesthesia in a patient with rheumatic heart disease, previous mitral valve replacement, and multiple co-morbidities. It highlights the role of the multidisciplinary Heart Team and multimodality imaging in reaching and implementing an appropriate management plan in this complex patient group. doi: 10.1111/
jocs.12324 (J Card Surg 2015;30:256–259)
Aortic valve replacement in patients with multiple comorbidities and concomitant mechanical mitral valve replacement is challenging. In this case, we describe carotid-access transcatheter aortic valve replacement (TAVR) under regional anaesthesia in a high-risk patient. PATIENT PROFILE A frail 80-year-old female presented with severe aortic stenosis. She had a history of rheumatic mitral stenosis having undergone mitral valvotomy via a left lateral thoracotomy in 1952 and a St. Jude mechanical mitral valve (size 29) replacement (MVR) (St. Jude Medical, Inc., St. Paul, MN, USA) in 1996. Comorbidities included permanent atrial fibrillation (AF), chronic renal impairment (creatinine 1.14 mg/dL; eGFR 49 mL/min), and severe obstructive pulmonary disease (FEV1 0.61 L [46% predicted], FVC 1.02 L [61% predicted], FEV1/FVC 60% [81% predicted]). Multimodality imaging was performed and her case discussed by the Heart Team.
Conflict of interest: Dr. Modine, Dr. Manoharan, and Dr. Spence are proctors for Medtronic Corevalve1. Institutional Review Board (IRB) permission was not required to report this case. Address for correspondence: Dr. Michael J. Daly, M.B.B.Ch., M.R. C.P., The Heart Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, United Kingdom. E-mail: michaeljdaly@hotmail. com
The consensus opinion was that conventional surgical aortic valve replacement (sAVR) carried excessive risk due to both her frailty and multiple comorbidities (Logistic EUROscore 42.6% and STS risk of mortality 17.6%). Multimodality imaging demonstrated small (
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SURGICAL TECHNIQUE ___________________________________________________________
Carotid-Access Transcatheter Aortic Valve Replacement in a Patient with a Previous Mitral Valve Replacement Michael J. Daly, M.B.B.Ch., M.R.C.P.,* Paul H. Blair, M.D., F.R.C.S.,* Thomas Modine, M.D.,y Patrick M. Donnelly, M.D., F.R.C.P.,z Reuben Jeganathan, M.D., F.R.C.S. (C.Th.),* Ganesh Manoharan, M.D., F.R.C.P.,* and Mark S. Spence, M.D., F.R.C.P.* *The Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom; yHeart Team, Lille University Hospital, Lille, France; and zThe Ulster Hospital, Dundonald, Belfast, United Kingdom ABSTRACT We describe a case of transcatheter aortic valve replacement (TAVR) using carotid artery access and regional anesthesia in a patient with rheumatic heart disease, previous mitral valve replacement, and multiple co-morbidities. It highlights the role of the multidisciplinary Heart Team and multimodality imaging in reaching and implementing an appropriate management plan in this complex patient group. doi: 10.1111/
jocs.12324 (J Card Surg 2015;30:256–259)
Aortic valve replacement in patients with multiple comorbidities and concomitant mechanical mitral valve replacement is challenging. In this case, we describe carotid-access transcatheter aortic valve replacement (TAVR) under regional anaesthesia in a high-risk patient. PATIENT PROFILE A frail 80-year-old female presented with severe aortic stenosis. She had a history of rheumatic mitral stenosis having undergone mitral valvotomy via a left lateral thoracotomy in 1952 and a St. Jude mechanical mitral valve (size 29) replacement (MVR) (St. Jude Medical, Inc., St. Paul, MN, USA) in 1996. Comorbidities included permanent atrial fibrillation (AF), chronic renal impairment (creatinine 1.14 mg/dL; eGFR 49 mL/min), and severe obstructive pulmonary disease (FEV1 0.61 L [46% predicted], FVC 1.02 L [61% predicted], FEV1/FVC 60% [81% predicted]). Multimodality imaging was performed and her case discussed by the Heart Team.
Conflict of interest: Dr. Modine, Dr. Manoharan, and Dr. Spence are proctors for Medtronic Corevalve1. Institutional Review Board (IRB) permission was not required to report this case. Address for correspondence: Dr. Michael J. Daly, M.B.B.Ch., M.R. C.P., The Heart Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, United Kingdom. E-mail: michaeljdaly@hotmail. com
The consensus opinion was that conventional surgical aortic valve replacement (sAVR) carried excessive risk due to both her frailty and multiple comorbidities (Logistic EUROscore 42.6% and STS risk of mortality 17.6%). Multimodality imaging demonstrated small (
