Role of monitored anaesthesia care in peri-procedural stroke during
unprotected transfemoral aortic valve replacement: A case report
Abstract
Abstract: Backgraound: Transcatheter aortic valve implantation (TAVI),
with its improved valve technologies will also be an option for patients
in the near future and improved operator experience. Cerebrovascular
events are among the most feared complications of TAVI, since they cause
high morbidity and mortality. Case: After the patient with EuroSCORE II
= 8.6% was considered to be at high risk in terms of surgery, the
decision to perform TAVI was taken. The valve (Medtronic 26 mm) was
successfully placed during the 110 min procedure. Blood loss was 140 mL,
no red blood cell (RBC) transfusion and catecholamines requirements were
present, no VF (ventricular fibrillation) and cardiac tamponade were
observed and post procedure left ventricular ejection fraction (LVEF)
was 60%. At the end of the procedure, the BIS value of the patient was
70, regression in the Glasgow Coma Score (GCS = 12), anisocoria in the
pupils (R = 2 mm < L = 4 mm) and motor loss in the right arm
(3/5) and right leg (3/5) were detected. Modified Rankin scale (mRS) was
evaluated as 4. Conclusions: The neurological complication rate of up to
80% during and in the days following the procedure, the long recovery
period after embolism, the possibility of being a nursing patient and
even the risk of death, remind us that the TAVI procedure and the
sedation given during the procedure should never be underestimated.
Keywords: Transcatheter aortic valve implantation, cerebral embolism,
complications, neuroradiology, monitorized anaesthesia care, aort
stenosis.