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

Abstract

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.

Local against general anesthesia for transcatheter aortic valve replacement

“…It is essential to note that, even though the application of TEE has been a protective factor against the development of AR, other variables may influence the findings (22). In a similar vein, some researchers discovered substantial variations in the requirement for permanent pacemaker implantation in favor of individuals receiving GA, whereas we did not observe any such differences in our experience (23).…”