title: Bivalirudin and transcatheter aortic valve replacement: a cautionary tale.
abstract: Bivalirudin is an accepted alternative to heparin for anticoagulation during select cardiac procedures. Its use has not been well described during transcatheter aortic valve replacement. Herein is the report of a transcatheter valve replacement case that was complicated by catastrophe and need for emergent cardiopulmonary bypass. A successful outcome was achieved. However, the inability to rapidly reverse the anticoagulation effect of bivalirudin proved troublesome, and that provides for a cautionary tale about its use during transcatheter valve replacement.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Niravkumar K
authors.initials: NK
authors.lastname: Sangani
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: greason.kevin@mayo.edu.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Norman E
authors.initials: NE
authors.lastname: Torres
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Verghese
authors.initials: V
authors.lastname: Mathew
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001022:Aortic Valve Insufficiency / Q000139:chemically induced* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D006350:Heart Valve Prosthesis; D006629:Hirudins / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000008:administration & dosage / Q000009:adverse effects*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin