Background and Aim: Patients affected by acute heart failure with associated severe valvular heart disease exhibit poor prognosis with early reduced late survival. Bridge strategies have been used to stabilize patient in order to perform to the surgical treatment or HTX in best achievable clinical condition. Data on TAVR as bridge strategy are scarce and still un-investigated Clinical case: A 34 y.o. male patient presented with acute cardiogenic shock in our emergency unit. Echocardiography showed poor left (EF 25%) and right ventricular function (TAPSE 10 mm) with severe aortic regurgitation and moderato-severe functional mitral regurgitation. Patient history was characterized by a previous AVR with biological valve and sequent redo procedure with aortic homograft implantation five years before. Medical management with 5 y/kg/min dobutamine and loop diuretics was started. Transesopahgeal echocardiography showed complete prolapse of aortic homograft leaflet into LV causing massive AR. CT scan showed a complete calcification the homograft up to aortic arch. We faced with an inotrope dependent (INTERMARCS 3) patient and no mechanical support feasible due to AR. Patient was in extremely high surgical risk due to clinical conditions and anatomy (calcified homograft). In this setting, urgent heart transplant may be rarely considered for too advanced anatomical contidtions and poor LV function. Heart Team discussion suggested to attempt a bridge TAVR to solve AR. Anatomy was screened for TAVI procedure and a Medtronic Evolut FX 34 mm valve was chosen to mitigate risk of rapid pacing and homograft rupture. Procedure was safely performed with stand by ECMO. Patient was weaned from inotropic support with immediate improvement of biventicular function and discharged for rehabilitation after 7 day. -30 day FU was uneventfull. Conclusion: Role of TAVR as bridge strategy may underline a novel application of this technology also in young patients with heart falure. This patient is even out from HTX programme at 30 day.
Associazione Nazionale Medici Cardiologi Ospedalieri
