Recurrence of Left Ventricular Outflow Tract Obstruction Requiring Alcohol Septal Ablation after Transcatheter Aortic Valve Implantation

Kitahara, Hideki; Mastuura, Kaoru; Sugiura, Akira; Yoshimura, Akiko; Muramatsu, Takahiro; Tamura, Yusaku; Nakayama, Takashi; Fujimoto, Yoshihide; Matsumiya, Goro; Kobayashi, Yoshio

doi:10.1155/2018/5026190

Cited by 5 publications

(5 citation statements)

References 5 publications

(7 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most of the current literature is limited to case reports and series [4, 9‒11]. Several of these reports have described acute hemodynamic compromise after valve implantation; this is thought to be due to the abrupt decrease in afterload after valve placement and subsequent worsening of preexisting dynamic left ventricular outflow tract obstruction (LVOTO).…”

Section: Discussionmentioning

confidence: 99%

Endovascular Transcatheter Aortic Valve Replacement Outcomes in Hypertrophic Cardiomyopathy: Insights from the National Inpatient Sample (2014–2018)

Vyas¹,

Nazir²,

Ahuja³

et al. 2023

Cardiology

View full text Add to dashboard Cite

Background: Outcomes of patients with hypertrophic cardiomyopathy (HCM) following transcatheter aortic valve replacement (TAVR) remain largely unknown. Objectives: This study sought to assess the clinical characteristics and outcomes of HCM patients following TAVR. Methods: We queried the National Inpatient Sample from 2014 to 2018 for TAVR hospitalizations with and without HCM, creating a propensity-matched cohort to compare outcomes. Results: 207,880 patients that underwent TAVR during the study period, 810 (0.38%) had coexisting HCM. In the unmatched population, TAVR patients with HCM compared to those without HCM, were more likely to be female, had a higher prevalence of heart failure, obesity, cancer, and history of pacemaker/implantable cardioverter defibrillation, and were more likely to have nonelective and weekend admissions (p for all <0.05). TAVR patients without HCM had higher prevalence of coronary artery disease, prior percutaneous coronary intervention, prior coronary artery bypass grafting, and peripheral arterial disease compared to their counterparts (p for all <0.05). In the propensity-matched cohort, TAVR patients with HCM had significantly higher incidence of in-hospital mortality, acute kidney injury/hemodialysis, bleeding complications, vascular complications, permanent pacemaker requirement, aortic dissection, cardiogenic shock, and mechanical ventilation requirement. Conclusion: Endovascular TAVR in HCM patients is associated with an increased incidence of in-hospital mortality and procedural complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Endovascular Transcatheter Aortic Valve Replacement Outcomes in Hypertrophic Cardiomyopathy: Insights from the National Inpatient Sample (2014–2018)

Vyas¹,

Nazir²,

Ahuja³

et al. 2023

Cardiology

View full text Add to dashboard Cite

show abstract

“…Currently, ASA has been reported to be a bail-out therapeutic choice to manage severe intraventricular gradient after TAVI. 4 , 5 , 10–12 Alcohol septal ablation is less invasive than surgical resection. However, up to 20% of patients might not have an appropriate septal artery.…”

Section: Discussionmentioning

confidence: 99%

“…Since the haemodynamic profile of such cases is similar to those of patients with hypertrophic cardiomyopathy, alcohol septal ablation (ASA) has been reported as a bail-out therapeutic choice. 4 , 5 However, some cases might not be eligible for ASA due to technical issues. We describe the case of a patient who we successfully treated with medication and dual-chamber pacing after recovery from acute haemodynamic collapse by temporary pacing from the right ventricular (RV) apex.…”

Section: Introductionmentioning

confidence: 99%

Haemodynamic collapse immediately after transcatheter aortic valve implantation due to dynamic intraventricular gradient: a case report and review of the literature

Endo

Otsuki

Domoto

et al. 2021

European Heart Journal - Case Reports

View full text Add to dashboard Cite

Background Dynamic intraventricular obstruction after transcatheter aortic valve implantation (TAVI) has been previously reported. There is a risk of haemodynamic collapse in the case of left ventricular outflow tract (LVOT) obstruction due to systolic anterior motion (SAM) of the mitral valve. Case summary An 83-year-old woman with aortic stenosis (AS) was referred to our hospital for TAVI. Transthoracic echocardiography revealed a severely calcified aortic valve with a peak velocity of 6.3 m/s across the valve. Acceleration of blood flow (peak velocity 2.6 m/s) at the LVOT due to a septal bulge was also seen. Transfemoral TAVI was performed, and a 29 mm Evolut PRO was implanted under general anaesthesia. After the implantation, a complete atrioventricular block with junctional rhythm developed, and refractory hypotension occurred immediately. Transoesophageal echocardiography revealed LVOT obstruction due to SAM of the mitral valve associated with severe mitral regurgitation (MR), which was not observed preoperatively. Fluid infusion and catecholamine administration were not effective. However, after performing temporary pacing from the right ventricular (RV) apex, the LVOT obstruction and severe MR improved. Her haemodynamics stabilized, and we could complete the procedure. A dual-chamber permanent pacemaker with beta-blocker administration as a longer-term treatment further improved the LVOT obstruction. The patient was finally discharged to a rehabilitation hospital. Discussion Alertness and recognition of potential LVOT obstruction after TAVI are important. Pacing from the RV apex, as well as dual-chamber pacing, comprise a less invasive and feasible therapeutic option in such cases.

show abstract

“…TAVI for AS complicated with HOCM would introduce hemodynamic collapse due to deteriorated LVOTO caused by the abrupt afterload decrease. 5,6) In contrast, PTSMA for LVOTO would develop complete AV block as complication for remaining severe AS. As mentioned above, there are controversy about the perioperative management of AS and coexisting HOCM undergoing TAVI.…”

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

View full text Add to dashboard Cite

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.

show abstract

Recurrence of Left Ventricular Outflow Tract Obstruction Requiring Alcohol Septal Ablation after Transcatheter Aortic Valve Implantation

Cited by 5 publications

References 5 publications

Endovascular Transcatheter Aortic Valve Replacement Outcomes in Hypertrophic Cardiomyopathy: Insights from the National Inpatient Sample (2014–2018)

Endovascular Transcatheter Aortic Valve Replacement Outcomes in Hypertrophic Cardiomyopathy: Insights from the National Inpatient Sample (2014–2018)

Haemodynamic collapse immediately after transcatheter aortic valve implantation due to dynamic intraventricular gradient: a case report and review of the literature

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

Contact Info

Product

Resources

About