Transapical Aortic Valve Replacement Aided by Cardiopulmonary Bypass in
a Patient with a Left Ventricular Thrombus
Abstract
Aortic stenosis is one of the most common degenerative valvular diseases
in the elderly. Transapical aortic valve implantation (TAVI) is an
innovative technique for high-risk patients with severe, symptomatic
aortic stenosis and multiple comorbidities. However, potential
obstruction to the left ventricular outflow tract, from a left
ventricular thrombus, poses significant patient risk and challenge for
the anesthetist. An 82-year-old man with these conditions underwent TAVI
and intracardiac thrombectomy under general anesthesia, combined with
cardiopulmonary bypass. We abandoned traditional surgical aortic valve
replacement and thrombectomy; a fast-track cardiac anesthesia strategy
was adopted. No complications were observed during recovery. Cardiac
function was normal upon follow-up 1 year, post-operatively. Transapical
aortic valve replacement aided by cardiopulmonary bypass, implemented
under Enhanced Recovery After Surgery (ERAS) strategy, is suitable for
high-risk patients under similar conditions. Strategies and equipment
should be maximized for analgesia, organ protection, and circulatory
homeostasis for perioperative safety and enhanced prognosis.