Transcatheter aortic valve replacement via a transsubclavian approach in a patient with severe aortic stenosis who had previously undergone kidney transplantation: A case report.

Oh, Seok; Kim, Ju Han; Hyun, Dae Young; Cho, Kyung Hoon; Kim, Min Chul; Sim, Doo Sun; Hong, Young Joon; Ahn, Youngkeun; Jeong, Myung Ho; Lee, Kyo Seon
Medicine
2021Oct ; 100 ( 39 ) :e27210.
저자 상세정보
Oh, Seok - Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Kim, Ju Han - Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Hyun, Dae Young - Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Cho, Kyung Hoon - Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Kim, Min Chul - Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Sim, Doo Sun - Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Hong, Young Joon - Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Ahn, Youngkeun - Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Jeong, Myung Ho - Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Lee, Kyo Seon - Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwangju, Korea.
ABSTRACT
RATIONALE: Although the transfemoral approach is the gold standard for transcatheter aortic valve replacement (TAVR), it is not feasible in a considerable number of patients. We report a case of successful transsubclavian TAVR (TS-TAVR) in a patient with severe aortic stenosis (AS) who was ineligible for transfemoral TAVR because she was a kidney transplant recipient. PATIENT CONCERNS: A 72-year-old Korean woman, who had previously undergone kidney transplantation in the right iliac fossa for end-stage kidney disease, was admitted to our center with dyspnea. Upon auscultation, grade IV systolic murmurs were detected in both upper sternal borders and the left lower sternal border, suggestive of valvular heart disease. DIAGNOSIS: Two-dimensional transthoracic echocardiography revealed heavy calcification of the aortic valve with a high peak velocity (4.54?m/s) and mean pressure gradient (48.49?mm?Hg), indicative of severe AS. INTERVENTIONS: TS-TAVR was performed by a heart team comprised of interventional cardiologists, cardiac surgeons, and anesthesiologists. A self-expandable valve prosthesis (CoreValveTM Evolut RTM, Medtronic Inc., Minneapolis, MN) was successfully deployed via the left subclavian artery. OUTCOMES: Post-TAVR 2-dimensional transthoracic echocardiography demonstrated a well-functioning valve with mild paravalvular leakage. The peak velocity had declined from 4.54?m/s to 2.22 to 2.24?m/s, and the mean pressure gradient had declined from 48.49 to 8.57-9.61?mmHg. The patient was discharged successfully and uneventfully. LESSONS: Because kidney transplant recipients with severe AS are considered poor candidates for transfemoral TAVR, TS-TAVR is a suitable alternative to consider. CI - Copyright ??2021 the Author(s). Published by Wolters Kluwer Health, Inc.
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MESH
Aged, Aortic Valve Stenosis/*surgery, Female, Humans, *Kidney Transplantation, Postoperative Complications/*surgery, Severity of Illness Index, Subclavian Artery, Transcatheter Aortic Valve Replacement/*methods
링크

주제코드
주제명(Target field)
연구대상(Population)
연구참여(Sample size)
대상성별(Gender)
질병특성(Condition Category)
연구환경(Setting)
연구설계(Study Design)
연구기간(Period)
중재방법(Intervention Type)
중재명칭(Intervention Name)
키워드(Keyword)
유효성결과(Recomendation)
Post-TAVR 2-dimensional transthoracic echocardiography demonstrated a well-functioning valve with mild paravalvular leakage; this report highlights that KTRs are poor candidates for TF-TAVR and that TS-TAVR is a useful alternative.
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
출판년도(Year)
참여저자수(Authors)
대표저자
DOI
10.1097/MD.0000000000027210
KCD코드
ICD 03
건강보험코드