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Successfully minimal approach ViV-TAVR without angiography in a severe restenosis with renal dysfunction 17 years

Xiaofei Jiang1, Zhe Zhang1, Kun Wang1

  • 1Cardiology Department, Zhuhai People's Hospital, (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong, P. R. China.

Perfusion
|November 19, 2020
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) can be performed without angiography in patients with recurrent aortic stenosis and kidney dysfunction. This angiography-free TAVR approach may improve outcomes for high-risk patients.

Area of Science:

  • Cardiovascular Interventional Therapy
  • Nephrology
  • Geriatric Medicine

Background:

  • Severe aortic stenosis (AS) is a significant cause of death in elderly individuals.
  • Transcatheter aortic valve replacement (TAVR) is a key treatment, but often involves patients with advanced heart failure and chronic kidney disease.
  • Pre-procedural imaging like CT and angiography is standard for TAVR but can worsen kidney function.

Observation:

  • A patient with severe recurrent AS after prior surgical aortic valve replacement (SAVR) and worsening renal dysfunction was considered for TAVR.
  • Standard angiography was contraindicated due to renal impairment.
  • Valve-in-valve (ViV) TAVR was successfully performed using pre-procedural evaluation without angiography.

Findings:

  • The angiography-free ViV TAVR successfully treated the restenosis.
  • The patient's renal function did not deteriorate post-procedure.
  • This approach avoided contrast-induced acute kidney injury (CI-AKI).

Implications:

  • Angiography-free TAVR is a viable and potentially safer option for patients with aortic restenosis and renal dysfunction.
  • This strategy may expand TAVR eligibility for high-risk populations.
  • Minimizing contrast exposure is crucial for patients with compromised kidney function undergoing TAVR.

Keywords:
Transcatheter aortic valve replacementacute kidney injuryangiography-freevalve-in-valve

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