Initial experience with transcatheter aortic valve replacement before and after lung transplant

Area of Science:

• Cardiology
• Thoracic Surgery
• Transplantation Medicine

Background:

• Patients with end-stage lung disease and lung transplant (LTx) recipients are at high risk for surgical aortic valve replacement (AVR).
• Transcatheter AVR (TAVR) is an established treatment for aortic stenosis, but its use in the LTx population is limited.

Purpose of the Study:

• To report the experience of TAVR in patients who underwent the procedure before or after lung transplantation.
• To evaluate the safety and feasibility of TAVR in this high-risk patient group.

Main Methods:

• A single-center, retrospective analysis of 10 patients who underwent TAVR between 2000 and 2020, either pre- or post-LTx.
• Review of indications, anesthesia, timing of TAVR, and procedural outcomes.
• Analysis of outcomes in both the TAVR pre-LTx and TAVR post-LTx groups.

Main Results:

• 10 LTx patients underwent TAVR for aortic stenosis (5 pre-LTx, 5 post-LTx).
• All TAVRs were transfemoral, with 90% performed under monitored anesthesia care.
• The primary complication was heart block requiring a pacemaker (2 patients total). No intraprocedural mortalities or need for surgical AVR conversion occurred.

Conclusions:

• TAVR is safe and feasible for treating aortic stenosis in patients awaiting LTx and in LTx recipients.
• TAVR offers a viable alternative to surgical AVR in these high-risk populations.
• Consideration of TAVR is recommended for patients with end-stage lung disease and LTx recipients requiring AVR.