Single-access, non-contrast transcatheter aortic valve implantation, the ultimate minimalist approach: a case report

Abstract

Background Transcatheter aortic valve implantation (TAVI) is an established treatment for patients with symptomatic severe aortic stenosis. Patients with previous renal transplant are considered as a high-risk cohort who may develop procedural complications related to vascular access and renal impairment post TAVI. Case summary Herein, we report a case of an 88-year-old male who presented with progressive dyspnoea. His transthoracic echocardiogram revealed severe aortic stenosis with peak gradient of 75 mmHg and impaired left ventricle systolic function (estimated ejection fraction of 40%). He has a background of kidney transplant with progressive decline in renal function requiring the formation of left arm arteriovenous fistula in preparation for future dialysis. He was successfully treated with TAVI using a single vascular access site without administering contrast media. Conclusion Single access, non-contrast TAVI is feasible when treating renal transplant patients with severe aortic stenosis and limited vascular access. The current minimalistic approach should be only used in highly selected cases.