title: Transfemoral aortic valve implantation in a renal transplant patient with a Dacron aorto-bi-iliac bypass.
abstract: Transcatheter aortic valve implantation (TAVI) is becoming the standard of care for inoperable patients with symptomatic severe aortic stenosis and the transfemoral approach is generally the first option chosen. However, transfemoral aortic valve replacement is contraindicated in patients with a Dacron aorto-bi-iliac bypass. To the best of our knowledge, we present the first case report of transfemoral aortic valve implantation in a kidney transplant patient with a history of aorto-bi-iliac bypass. His predicted operative mortality of 45% for aortic valve replacement was prohibitive according to the Society of Thoracic Surgeons score. A 26 mm Sapien XT valve (Edwards) was successfully implanted. Inotropic support was required for the four days following the procedure, after which, he was weaned uneventfully. A permanent pacemaker implantation was necessary at day six to treat a symptomatic paroxysmal complete atrio-ventricular block. The patient made an excellent recovery with no further complications and has remained asymptomatic at six months. This case highlights the importance of a detailed anatomic vascular assessment combined with a multidisciplinary evaluation of the access site in patients evaluated for TAVI. We used multi-slice computed tomography scans of the iliofemoral arteries, the aorto-bi-iliac bypass and the thoraco-abdominal aorta to predict the potential pitfalls of a fully percutaneous transfemoral aortic valve implantation. The transfemoral approach was finally chosen in this case after considering the patient's suitable aorto-iliofemoral vasculature, his patent coronary artery bypass grafts and his predisposition for severe acute kidney injury.
authors.affiliation: Department of Interventional Cardiology, Université Paris Sud, Centre Marie Lannelongue, 133 Av de la résistance, 92350 Le Plessis Robinson, France. joeelie.salem@gmail.com
authors.forename: Joe-Elie
authors.initials: JE
authors.lastname: Salem
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Paul
authors.forename: Christophe
authors.initials: C
authors.lastname: Caussin
mesh_terms: D000368:Aged; D001011:Aorta; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D000075202:Contraindications; D001026:Coronary Artery Bypass; D005263:Femoral Artery; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007083:Iliac Artery; D016030:Kidney Transplantation; D008297:Male; D017202:Myocardial Ischemia / Q000601:surgery; D011093:Polyethylene Terephthalates; D016896:Treatment Outcome
chemical_list: D011093:Polyethylene Terephthalates