Related Experiment Video
Updated: Jul 9, 2025
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Transcatheter aortic valve replacement for aortic insufficiency in a patient with aortic root Thrombus and left
Anureet Malhotra1, Tarun Dalia2, George L Zorn3
1Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Insights
A patient with a left ventricular assist device (LVAD) and severe aortic insufficiency (AI) with an aortic root thrombus (ART) successfully underwent transcatheter aortic valve replacement. This minimally invasive approach offers an alternative to traditional cardiac transplantation for managing this complex condition.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Left ventricular assist device (LVAD) implantation is a critical intervention for end-stage heart failure.
- Aortic insufficiency (AI) and aortic root thrombus (ART) are serious complications that can arise in patients with LVADs.
- Management of severe AI in the presence of ART in LVAD patients traditionally necessitates cardiac transplantation.
Observation:
- A 61-year-old male with an LVAD developed recurrent ventricular tachycardia and worsening heart failure.
- Imaging revealed progression of AI and a persistent ART, despite medical management.
- The patient was deemed ineligible for cardiac transplantation due to frailty.
Findings:
- A successful transcatheter aortic valve replacement (TAVR) using a Sapien S3 valve was performed.
- Distal protection filters were employed during TAVR for stroke prevention.
- This case demonstrates a novel, minimally invasive treatment strategy for severe AI in an LVAD patient with ART.
Implications:
- This case highlights TAVR as a viable alternative for managing severe AI in complex LVAD patients.
- Physicians should consider TAVR for LVAD patients with AI and ART who are not transplant candidates.
- This approach may improve outcomes and expand treatment options for this challenging patient population.
Abstract:
A 61-year-old man with end-stage ischemic cardiomyopathy post HeartMate 3 (Abbott laboratories, Chicago, Illinois, USA) left ventricular assist device (LVAD) implant was hospitalized after he had recurrent ventricular tachycardia requiring implantable cardioverter-defibrillator shocks. His transthoracic echocardiogram and computed tomography angiography of the chest showed presence of trace aortic insufficiency (AI) and aortic root thrombus (ART) of non-coronary cusp without obstruction of right or left coronary artery ostium despite therapeutic international normalized ratio. He presented again 3 months later with worsening heart failure signs and symptoms. Transesophageal echocardiogram showed progression to severe AI and persistent ART. Despite hemodynamically guided LVAD speed optimization, inotropic support, and diuresis, the patient continued to deteriorate with worsening renal function. The patient was not a transplant candidate due to frailty. After multi-disciplinary discussion he underwent successful 29-Sapien S3 (Edwards Lifesciences, Irvine, CA, USA) transcatheter aortic valve replacement utilizing distal protection filters in bilateral internal carotid arteries for stroke prevention. This case provides novel insight to physicians treating LVAD patients regarding management of severe AI in the setting of ART.
Learning Objective:
We report a rare approach employed for management of aortic insufficiency (AI) in a patient who also had an aortic root thrombus and left ventricular assist device (LVAD) that traditionally requires cardiac transplantation. Our patient had a favorable outcome with a minimally invasive transcatheter aortic valve replacement. With this case, we hope to generate awareness amongst physicians treating patients about management alternatives and approach of a commonly encountered, life-threatening complication of AI in patients with LVAD.
