AB138. SOH24AB_116. Emergency transcatheter aortic valve implantation in acute decompensated heart failure with multi-organ failure due to aortic insufficiency: a case report

Background: Acute decompensated heart failure (ADHF) is a critical cardiovascular condition that requires prompt intervention. Aortic insufficiency, commonly known as aortic regurgitation (AR), contributes to ADHF, leading to hemodynamic instability. In cases where traditional surgical aortic valve replacement (AVR) may not be feasible, transcatheter aortic valve implantation (TAVI) emerges as a viable alternative.

Case Description: Herein, we report a 71-year-old male patient presenting with multi-organ failure due to aortic insufficiency. A 71-year-old gentleman with a history of coronary artery disease (CAD) and severe aortic stenosis for which he underwent coronary artery bypass surgery (CABG) and bioprosthetic AVR 12 years prior, presented in ADHF. Transoesophageal echocardiography (TOE) showed left ventricular dysfunction and apical hypokinesis. TOE also showed severe eccentric AR due to structural valve deterioration of the bioprosthetic AVR. The patient’s clinical status subsequently deteriorated. He developed a cardio-renal syndrome, ultimately requiring continuous venovenous hemodiafiltration, as well as an acute ischaemic liver injury. The multidisciplinary team deemed him unsuitable for surgical re-operation; a valve-in-valve TAVI was chosen. The TAVI was implanted via a transfemoral approach without any complication. The patient’s clinical status improved immediately, and was weaned off haemodialysis and inotropic support. Additionally, the follow-up data one-year post-TAVI presents a positive picture of sustained improvement in the patient’s clinical status.

Conclusions: This case documents the successful management of advanced AR-induced multi-organ failure through emergency valve-in-valve TAVI. The absence of significant procedural complications, as well as the absence of valve-related complications post-TAVI, further emphasizes the effectiveness and safety of the selected intervention.

Keywords: Acute decompensated heart failure (ADHF); aortic insufficiency; aortic valve replacement (AVR); cardio-renal syndrome; transcatheter aortic valve implantation (TAVI)