Transcatheter aortic valve replacement for left ventricular assist device-related aortic regurgitation and prohibitive surgical risk: a case report

TL;DR

This case report describes a successful transcatheter aortic valve replacement in a high-risk patient with aortic regurgitation following a heart pump implant.

Contribution

The paper presents a novel case of transcatheter aortic valve replacement for LVAD-related aortic regurgitation in a patient with prohibitive surgical risk.

Findings

Transcatheter aortic valve replacement improved right ventricular function and reduced pulmonary pressures.

The procedure decreased mitral regurgitation and stabilized the patient's condition.

Percutaneous interventions are viable for managing high-risk aortic regurgitation in LVAD patients.

Abstract

Aortic regurgitation (AR) is a prevalent complication following left ventricular assist device (LVAD) implantation, which elevates the risk of mortality. Prompt recognition and intervention are crucial to mitigate this risk.

A 52-year-old male with severe left ventricular dysfunction secondary to Chagas cardiomyopathy and severe pulmonary hypertension underwent implantation of a HeartMate 3 device as a bridge to transplant candidacy. Post-implantation, he developed progressive AR and a decline in overall health, characterized by right ventricular dysfunction, worsening mitral regurgitation, and elevated pulmonary pressures. Given the very high surgical risk, transcatheter aortic valve replacement was successfully performed, yielding excellent outcomes, including normalization of right ventricular function, reduction in pulmonary pressures, and a decrease in mitral regurgitation.

Aortic regurgitation is a progressive complication in patients with continuous flow-LVAD, limits effective blood flow, and can lead to severe outcomes like biventricular failure, high rates of hospitalization, and mortality. Managing AR is challenging, often requiring percutaneous interventions due to high surgical risks. Treatment choices depend on centre expertise and patient specifics.

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