Transfemoral balloon expandable aortic valve implantation in a patient with myelodysplastic syndrome

Transcatheter aortic valve implantation in a patient with aplastic anemia

Aplastic anemia is a syndrome involving pancytopenia caused by bone marrow insufficiency. Pancytopenia increases the surgical risk of bleeding and infection. Here, we report a successful transcatheter aortic valve implantation (TAVI) in a patient with aplastic anemia. The patient was a 76-year-old woman who was admitted to our hospital with syncope. Laboratory testing showed pancytopenia, and echocardiography revealed severe aortic valve stenosis. Although the log.EuroSCORE and STS Score were not overly high, because of the presence of pancytopenia, surgical aortic valve replacement was considered too high risk, making her a candidate for TAVI. In this case, the patient's pancytopenia was so severe that even TAVI without preparation was considered high risk. In light of this, we carried out a two-day preoperative administration of granulocyte colony-stimulating factor and transfused packed red blood cells and platelet concentrates. TAVI was performed via the left femoral artery using the cut-down procedure under general anesthesia. The postoperative course was uneventful, and she was discharged on the sixth postoperative day. With adequate preoperative preparation, TAVI may be performed safely in high-risk patients with hematologic disorders. <Learning objective: Transcatheter aortic valve implantation (TAVI) is widely performed for aortic stenosis patients at high surgical risk. Although patients with severe pancytopenia can be candidates for TAVI, severe pancytopenia may increase the surgical risk even for TAVI. To reduce the risk, adequate preparations before the procedure are required. Here, we report the preoperative preparation before TAVI that lowered the surgical risk in a patient with severe pancytopenia.>.