Association of Hypertrophic Obstructive Cardiomyopathy With Outcomes Following Transcatheter Aortic Valve Replacement

Bandyopadhyay, Dhrubajyoti; Chakraborty, Sanjoy; Amgai, Birendra; Kapadia, Samir; Braunwald, Eugene; Naidu, Srihari S.; Kalra, Ankur

doi:10.1001/jamanetworkopen.2019.21669

Cited by 18 publications

(8 citation statements)

References 4 publications

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“…7 Conversely, another study showed that TAVR in patient with concomitant HCM was associated with substantially worse in-hospital outcomes, including cardiogenic shock, renal failure, and death. 8 Overall, the presentation of severely obstructive HOCM and significant aortic stenosis is not uncommon, and that patients can undergo a combined surgical myectomy and AV replacement successfully along with optimal medical therapy as reported in our case.…”

Section: Discussionsupporting

confidence: 59%

Hypertrophic Obstructive Cardiomyopathy Associated with Moderate Aortic Stenosis in Symptomatic 75-Year-Old Female: A Case Report

Abonowara

2023

Libyan International Medical University Journal

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A 72-year-old female was found to have symptomatic hypertrophic obstructive cardiomyopathy associated with significant aortic stenosis. She was found to have severe left ventricular outflow tract obstruction, asymmetric septal hypertrophy, significant systolic anterior motion of the anterior mitral valve leaflet, and mitral regurgitation. She was also found to have moderate aortic stenosis that made the obstruction even worse which made the patient progressively symptomatic not responding to medical therapy. She eventually underwent cardiac surgery in form of left ventricular septal myomectomy and bioprosthetic aortic valve replacement (tissue AVR) with a size 23 tissue valve, aortic root enlargement with bovine pericardial patch. She is currently stable on optimal medical therapy, feels much better and stable cardiac-wise with much better quality of life.

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Section: Discussionsupporting

confidence: 59%

Hypertrophic Obstructive Cardiomyopathy Associated with Moderate Aortic Stenosis in Symptomatic 75-Year-Old Female: A Case Report

Abonowara

2023

Libyan International Medical University Journal

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“…In patients with significant LVOT obstruction, some degree of AS may be protective due to an increase in afterload. However, when the patient's AS progresses to the point of needing treatment, relief of the aortic valve obstruction with valve replacement leads to an immediate dramatic decrease in afterload and can acutely worsen LVOT obstruction with the potential for severe hemodynamic instability and a “suicide ventricle.” 7 While often these patients remain stable, the presence of hypertrophic cardiomyopathy with LVOT obstruction in patients undergoing TAVR has been shown to confer an increased incidence of postoperative cardiogenic shock (16.28 vs. 3.43%, p < .001) as well as increased in‐hospital mortality (18.6 vs. 2.91%, p < .001) 14 …”

Section: Discussionmentioning

confidence: 99%

The use of MitraClip to prevent posttranscatheter aortic valve replacement left ventricular “suicide”

Bode

Ahmed

Baron

et al. 2020

Cathet Cardio Intervent

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Patients with concomitant severe aortic stenosis (AS) and left ventricular outflow tract (LVOT) obstruction undergoing transcatheter aortic valve replacement (TAVR) are at risk for hemodynamic collapse due to a sudden decrease in afterload causing worsening LVOT obstruction. We present a case of an 88‐year‐old female with symptomatic, severe AS, and LVOT obstruction with systolic anterior motion (SAM) of the mitral leaflet in whom alcohol septal ablation was contraindicated secondary to a chronic total occlusion of the right coronary artery that filled retrograde via septal collaterals. MitraClip at the time of TAVR was successfully performed to treat SAM with subsequent stabilization of LVOT gradients despite treatment of the patient's AS. This novel approach may represent a feasible option to prevent hemodynamic complications after TAVR in patients with significant LVOT obstruction secondary to SAM and AS.

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“…A previous report demonstrated that concomitant HOCM was associated with substantially worse in-hospital outcomes, including cardiogenic shock, renal failure, and death, in patients undergoing TAVI. 4) There is a management dilemma in patients with AS and coexisting HOCM undergoing TAVI. TAVI for AS complicated with HOCM would introduce hemodynamic collapse due to deteriorated LVOTO caused by the abrupt afterload decrease.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Aortic Valve Implantation Following Permanent Pacemaker Implantation for Severe Aortic Stenosis Complicated with Hypertrophic Obstructive Cardiomyopathy

Takamura

Kobayashi

Inoue

et al. 2020

Journal of Transcatheter Valve Therapies

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Transcatheter aortic valve implantation (TAVI) is an established therapy for aortic stenosis (AS). However, concomitant hypertrophic obstructive cardiomyopathy (HOCM) was associated with substantially worse in-hospital outcomes including cardiogenic shock, renal failure, and death in patients undergoing TAVI. Furthermore, there were few reports on optimal management for AS complicated with HOCM. In this case, we report a Japanese man with severe AS and concomitant HOCM, who was successfully treated by TAVI following PPM implantation. Case Presentation: An 87-year-old man with severe AS and HOCM transferred to our institution for treatment. We were concerned that abrupt afterload decrease and complete atrioventricular (AV) block during the TAVI procedure would introduce hemodynamic collapse due to left ventricular outflow obstruction (LVOTO). Our heart team decided the strategy of permanent pacemaker (PPM) implantation followed by TAVI with optimal medication. After PPM implantation, the TAVI procedure via transfemoral approach could be performed safely without deterioration of LVOTO. He was discharged 4 days after TAVI procedure without any symptoms. Conclusion: Transfemoral TAVI following PPM implantation was safety and useful strategy for severe AS complicated with HOCM.

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Association of Hypertrophic Obstructive Cardiomyopathy With Outcomes Following Transcatheter Aortic Valve Replacement

Cited by 18 publications

References 4 publications

Hypertrophic Obstructive Cardiomyopathy Associated with Moderate Aortic Stenosis in Symptomatic 75-Year-Old Female: A Case Report

Hypertrophic Obstructive Cardiomyopathy Associated with Moderate Aortic Stenosis in Symptomatic 75-Year-Old Female: A Case Report

The use of MitraClip to prevent posttranscatheter aortic valve replacement left ventricular “suicide”

Transcatheter Aortic Valve Implantation Following Permanent Pacemaker Implantation for Severe Aortic Stenosis Complicated with Hypertrophic Obstructive Cardiomyopathy

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