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The role of transcatheter aortic valve replacement in the patients with severe aortic stenosis requiring major non-cardiac surgery

  • Taishi Okuno
  • Kazuyuki Yahagi
  • Yu Horiuchi
  • Yu Sato
  • Tetsu Tanaka
  • Keita Koseki
  • Akira Osanai
  • Motoi Yokozuka
  • Sumio Miura
  • Kengo TanabeEmail author
Original Article

Abstract

Severe aortic stenosis (AS) is considered as an independent risk factor for perioperative cardiac complications of non-cardiac surgery. Surgical aortic valve replacement should be considered before non-cardiac surgery in patients with symptomatic severe AS. However, recently, transcatheter aortic valve replacement (TAVR) has emerged as an alternative approach for selected AS patients. We sought to determine the safety and efficacy of TAVR in preparation for major non-cardiac surgery. From our retrospective database, seven patients who underwent TAVR in preparation for major non-cardiac surgery were identified, and their clinical and hemodynamic data were collected. After TAVR, a significant reduction in the mean transaortic pressure gradient from 54.0 (Interquartile range (IQR) 47.5–64.5) to 18.0 (IQR 12.5–19.0) mmHg (p = 0.016) and an increase in the calculated aortic valve area from 0.6 (IQR 0.6–0.7) to 1.3 (IQR 1.1–1.5) cm2 (p = 0.022) were noted. Non-cardiac surgery included lung segmentectomy and lymph node dissection, lung lobectomy, ileocecal resection, partial colectomy, partial nephrectomy, nephroureterectomy, laparoscopic nephrectomy, and laparoscopic nephroureterectomy. All the initial non-cardiac surgeries were performed without cardiac complications, under general anesthesia, 37 (IQR 32–74) days after TAVR. Two of the patients eventually needed additional non-cardiac surgery, which was performed uneventfully without the need for additional AS treatment. TAVR was an effective and safe procedure that might reduce the risk of general anesthesia and major non-cardiac surgery in severe AS.

Keywords

Valvular heart disease Aortic valve stenosis Transcatheter aortic valve replacement Non-cardiac surgery 

Abbreviations

AS

Aortic stenosis

BAV

Balloon aortic valvuloplasty

BNP

Brain natriuretic peptide

DAPT

Double antiplatelet therapy

EF

Ejection fraction

IQR

Interquartile range

SAVR

Surgical aortic valve replacement

STS

Society of Thoracic Surgeons

TAVR

Transcatheter aortic valve replacement

Notes

Compliance with ethical standards

Conflict of interest

Dr. Tanabe receives honoraria from Edwards Lifesciences, and Medtronic. Dr. Yokozuka receives honoraria from Edwards Lifesciences. Other authors report no conflicts of interest.

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Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2019

Authors and Affiliations

  • Taishi Okuno
    • 1
  • Kazuyuki Yahagi
    • 1
  • Yu Horiuchi
    • 1
  • Yu Sato
    • 1
  • Tetsu Tanaka
    • 1
  • Keita Koseki
    • 1
  • Akira Osanai
    • 2
  • Motoi Yokozuka
    • 3
  • Sumio Miura
    • 2
  • Kengo Tanabe
    • 1
    Email author
  1. 1.Division of CardiologyMitsui Memorial HospitalTokyoJapan
  2. 2.Division of Cardiovascular SurgeryMitsui Memorial HospitalTokyoJapan
  3. 3.Division of AnesthesiaMitsui Memorial HospitalTokyoJapan

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