TAVR For Moderate Aortic Regurgitation in Setting of LVAD Support
Document Type
Article
Abstract
Background: While TAVR for aortic stenosis has seen widescale implementation, there is limited data on use of TAVR for aortic insufficiency (AI). We summarize an off-label use of TAVR for moderate AI in the setting of LVAD support.
Case: 75 year-old male with destination therapy HeartMate II (Abbott) LVAD implanted in 2016 presented with NYHA class IV symptoms. He was hospitalized 7 months prior for volume overload and evidence of 3+ AI on TTE. He underwent right heart catheterization with the following pressures: right atrium: 13 mmHg, right ventricle: 60/12 mmHg, mean pulmonary artery: 36mmHg and pulmonary capillary wedge pressure: 22mmHg; Mean arterial pressure of 100 mmHg reduced to 80 mmHg with IV nitroglycerin. LVAD speed was increased by 200 RPM and mean arterial pressure was controlled to a goal of 70-80 mmHg. A follow up TTE showed improvement in his AI. At current admission, repeat TTE demonstrated recurrent moderate to severe AI and he was offered the options of undergoing guideline directed surgical aortic valve replacement (SAVR) or consideration for TAVR.
Decision-making: In the process of shared decision making, he preferred to pursue the option of TAVR. CT imaging was used to take measurements of aortic annulus diameter. An Edwards Sapien S3 valve was successfully placed via left transfemoral approach. At 1 month, his symptoms improved to NYHA class II with follow-up TTE showing a prosthesis that was well-seated without any paravalvular or transvalvular regurgitation.
Conclusion: This case demonstrates the importance of shared decision making as the use of available TAVR devices for aortic insufficiency in the setting of LVAD for destination therapy is likely to grow.
First Page
3708
DOI
10.1016/S0735-1097(23)04152-9
Publication Date
3-7-2023
Recommended Citation
Desai S, Kothari J, Katz M, Allen D. TAVR FOR MODERATE AORTIC REGURGITATION IN SETTING OF LVAD SUPPORT. Journal of the American College of Cardiology. 2023 Mar 7;81(8_Supplement):3708-.