Motorized transcatheter aortic valve implantation in a high-risk patient with severe aortic stenosis: A case report

Abstract

Background: Transcatheter aortic valve implantation (TAVI) is an effective therapy for severe aortic stenosis, especially in patients with high surgical risk due to complex cardiac history. Motorised valve delivery systems enable precise deployment, improving procedural outcomes.

Case Presentation: We report a 65-year-old male with newly diagnosed diabetes mellitus, a history of coronary artery disease (triple-vessel disease), status postprimary PCI to the left anterior descending artery (LAD) following an evolved anterior wall myocardial infarction (AWMI) with prior cardiac resuscitation, and old multifocal cerebrovascular infarcts. The patient also had recovered from acute decompensated heart failure and moderate left ventricular dysfunction. During follow-up, he was found to have severe calcific aortic stenosis with severe aortic regurgitation. On admission, he was conscious and oriented, pulse 74 bpm, BP 160/90 mmHg, S1/S2 audible, and bilateral air entry normal. He underwent successful transfemoral motorised TAVI under fluoroscopic and ultrasound guidance. Preprocedure gradient was 80/60 mmHg. Following balloon pre-dilatation with an 18 mm Z-MED II balloon, the motorised valve was deployed with optimal positioning. Post-procedure gradient was reduced to 13/6 mmHg with minimal paravalvular leak. The patient had an uneventful recovery and remained asymptomatic at 30-day follow-up.

Conclusion: This case illustrates the feasibility, safety, and efficacy of motorised TAVI in patients with severe aortic stenosis and multiple high-risk comorbidities, including prior myocardial infarction, PCI, cerebrovascular disease, and moderate LV dysfunction.