Balloon aortic valvuloplasty in adults: Failure of procedure to improve long-term survival

Lieberman, Eric B.; Bashore, Thomas M.; Hermiller, James; Wilson, John S.; Pieper, Karen S.; Keeler, Gordon; Pierce, Cynthia H.; Kisslo, Katherine B.; Harrison, J. Kevin; Davidson, Charles J.

doi:10.1016/0735-1097(95)00363-0

Cited by 266 publications

(140 citation statements)

References 23 publications

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“…Whereas balloon valvuloplasty represents an alternative therapeutic option, the reduction in stenosis is modest and temporary. 5,6 Percutaneous approaches to AV replacement have been investigated since 1992. 7 in 2002, Cribier et al 8 reported a successful percutaneous valve replacement via an antegrade transseptal approach through the femoral vein.…”

Section: éLéments Cliniques : Une Fois Le Consentement Du Comité D'étmentioning

confidence: 99%

Case series: anesthesia for retrograde percutaneous aortic valve replacement — experience with the first 40 patients

Ree

Bowering

Schwarz

2008

Can J Anesth/J Can Anesth

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Purpose: To describe both the evolution and the main associated complications in the anesthetic management of the initial 40 patients at our centre who underwent percutaneous retrograde aortic valve replacement, a novel technique utilizing a catheterguided femoral artery approach. Clinical features:With institutional Research Ethics Board approval, we retrospectively reviewed the medical records of the first 40 patients who underwent percutaneous retrograde aortic valve replacement between January 2005 and March 2006. Information obtained included patient characteristics, anesthetic management, details of the procedure, and complications. All procedures were scheduled to be performed in the cardiac catheterization laboratory. The first four patients received monitored anesthesia care, and the subsequent 36 underwent general anesthesia. There were no anesthesia-related adverse events. The prosthetic valve was placed successfully in 33/40 patients (83%). Median anesthetic time was 3.5 hr (range, 1.25-7.25 hr). Thirty-two/40 patients required vasopressor support. The most common, serious procedural complications were myocardial ischemia and arrhythmia following rapid ventricular pacing, hemorrhage from vascular injury secondary to the placement and removal of the large-bore sheath in the ilio-femoral artery, aortic rupture, and prosthetic valve maldeployment; 30-day mortality was 13% (n = 5/40). Conclusions:Percutaneous retrograde aortic valve replacement is a novel procedure that presents the anesthesiologist with unique challenges. Careful preoperative assessment, intraoperative monitoring appropriate for a major vascular procedure, and meticulous management of hemodynamics are imperative for a successful outcome. Serious complications, including major hemorrhage from vascular injury as well as arrhythmia and myocardial ischemia following rapid ventricular pacing, must be anticipated and managed in an expeditious fashion.

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Section: éLéments Cliniques : Une Fois Le Consentement Du Comité D'étmentioning

confidence: 99%

Case series: anesthesia for retrograde percutaneous aortic valve replacement — experience with the first 40 patients

Ree

Bowering

Schwarz

2008

Can J Anesth/J Can Anesth

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“…Furthermore, 60% of treated patients develop aortic restenosis or cardiovascular mortality within the first year of follow-up. 4 The advent of TAVI has made the treatment of inoperable patients possible, and TAVI is an alternative for those at high surgical risk; it has resulted in improvement in quality of life and survival rates. 5 Presently, TAVI is indicated for patients with symptomatic severe aortic stenosis who are not candidates for surgical aortic valve replacement.…”

mentioning

confidence: 99%

Transcatheter aortic valve implantation as rescue therapy for liver transplant candidates with aortic valve stenosis

et al. 2014

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TO THE EDITORS:Mortality rates as high as 29% have been reported for patients with end-stage liver disease (ESLD) who undergo cardiac surgery, with postoperative liver failure, sepsis, and bleeding accounting for these rates. 1 In noncardiac surgery scenarios, including liver transplantation, severe aortic stenosis carries a 31% perioperative risk of fatal and nonfatal cardiovascular events. 2 Consequently, a clinical dilemma emerges in cases of concurrent aortic stenosis and ESLD because the presence of one condition limits the treatment of the other. Moreover, in cases of congestive liver disease associated with aortic valve stenosis, treatment of the valvular disease remains the only therapeutic option for effectively improving liver function.We hypothesized, therefore, that transcatheter aortic valve implantation (TAVI) could be used as a less invasive alternative treatment for patients with concomitant ESLD and high-grade aortic valve stenosis and eventually turn these patients into eligible candidates for liver transplantation.To the best of our knowledge, the use of TAVI for patients with ESLD and severe aortic valve stenosis has not been reported previously. Our objective here is to report 2 patients with ESLD who benefited from TAVI therapy. This report was approved by the Institutional Review Committee.Patient 1, a 63-year-old man with ESLD, was admitted to the emergency room with dyspnea, lung crackles, jugular distension, diffuse edema, and a systolic murmur in the aortic area. Transthoracic echocardiography showed severe aortic stenosis with maximum and mean pressure gradients of 71 and 48 mm Hg, respectively. The indexed aortic valve area was 0.55 cm 2 . The end-diastolic left ventricular diameter was 55 mm, and the ejection fraction was 61% (Table 1). A previous diagnosis of cirrhosis due to a chronic hepatitis C virus infection complicated by hepatocellular carcinoma was established. Because of the thrombocytopenia, a platelet count of 60,000/ mm 3 , and a Model for End-Stage Liver Disease score of 16 points, the patient was considered at high risk for cardiac surgery. TAVI with an Edwards SAPIEN XT system (number 26, Edwards Lifesciences, Irvine, CA) was performed. The postprocedural period was uneventful, and the symptoms of heart failure improved during the course of the following week. Antiplatelet therapy was not prescribed because of the thrombocytopenia. After 1 month, his cardiac recovery was clinically complete, and this meant that the patient was considered eligible for liver transplantation. The patient underwent orthotopic liver transplantation 6 months after TAVI. No cardiovascular complications were observed, and the patient was discharged 5 days after the procedure.Patient 2, a 77-year-old man with a past history of diabetes mellitus, systemic arterial hypertension, and coronary artery disease with previous surgical myocardial revascularization, was referred for weekly paracentesis as a result of refractory ascites. He was diagnosed with nonalcoholic steatohepatitis complicated by ...

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“…Symptomatic patients managed medically have a poor prognosis (2,3). Although balloon aortic valvuloplasty has been used as an alternative treatment for high surgical risk patients, its benefit is typically short lived and does not alter the natural history of the condition (4,5).…”

mentioning

confidence: 99%

Percutaneous aortic valve implantation: A case report

Chandavimol

McClure

Carere

et al. 2006

Canadian Journal of Cardiology

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Balloon aortic valvuloplasty in adults: Failure of procedure to improve long-term survival

Cited by 266 publications

References 23 publications

Case series: anesthesia for retrograde percutaneous aortic valve replacement — experience with the first 40 patients

Case series: anesthesia for retrograde percutaneous aortic valve replacement — experience with the first 40 patients

Transcatheter aortic valve implantation as rescue therapy for liver transplant candidates with aortic valve stenosis

Percutaneous aortic valve implantation: A case report

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