2020 Volume 24 Issue 1 Pages 55-60
Purpose: Severe aortic stenosis (AS) is remarkable risk factor of major adverse cardiovascular events (MACE) in non-cardiac surgery. Although surgical aortic valve replacement (SAVR) before non-cardiac surgery is recommended for patients with severe AS, many patients are not appropriate for SAVR from their age, comorbidity and frailty. We considered that Transcatheter aortic valve replacement (TAVR) is alternative pre-treatment for patients with severe AS who was scheduled for non-cardiac surgery. Therefore, we report five cases who were performed TAVR prior to non-cardiac surgery in our hospital.
Method: Retrospective, case-series study.
Result: Our patients' median of age was 87 years old, median of days from TAVR to non-cardiac surgery was 78 days, and median of Society of Thoracic Surgery (STS) score was 4.9. After TAVR, 2 of 5 cases improved left ventricle ejection fraction (LVEF), and all cases decreased Brain natriuretic peptide (BNP). In all cases, antiplatelet therapy was introduced following TAVR, 3 of 5 was discontinued antiplatelet therapy and performed heparization until non-cardiac surgery was performed. One case was continued antiplatelet therapy, another case was discontinued antiplatelet therapy unintentionally. All cases had no thrombotic complication. In 4 cases, non-cardiac surgery was performed under general anesthesia. One case was performed under combination of spinal epidural anesthesia (CSEA). In all cases, MACE did not occur during non-cardiac surgery.
Conclusion: We concluded that in patients with severe AS scheduled for non-cardiac surgery, pre-treatment by TAVR is appropriate therapy for the patients' safety and improving outcome.
