Thoracic Endovascular Aortic Repair in a Patient with Dilated Cardiomyopathy and Low Ejection Fraction: A Case Report

Abstract

Background: Thoracic endovascular aortic repair (TEVAR) is a common treatment for high-risk patients with thoracic aortic aneurysms. However, these aneurysms are relatively rare in patients with dilated cardiomyopathy. We successfully treated a thoracic aortic aneurysm in an older patient who presented with dilated cardiomyopathy and low ejection fraction using TEVAR under general anesthesia. Case Presentation: An 84-year-old man was admitted to our institution with a thoracic aortic aneurysm, as well as dilated cardiomyopathy and an extremely low ejection fraction (15.4%). We scheduled the patient for TEVAR. Before administering general anesthesia, an external defibrillator was prepared for possible arrhythmia. General anesthesia was induced with 3 mg of intravenous midazolam and 100 μg of fentanyl. After endotracheal intubation, anesthesia was maintained with sevoflurane (1.2-1.5%). Intra-operative transesophageal echocardiography revealed that an end-diastolic internal diameter was about 65-70 mm and ejection fraction was 15-20%. Successful hemodynamic management during surgery was achieved with dopamine (1.6-2.4 μg/kg/min), noradrenaline (0.02-0.06 μg/kg/min), and milrinone (0.06 μg/kg/min). TEVAR was successfully performed without complication, and the patient's postoperative clinical course was uneventful. He was discharged 14 days after surgery. Conclusions: We describe the uncommon use of TEVAR in an older patient with dilated cardiomyopathy and an extremely low ejection fraction. This case demonstrates that this minimally invasive surgery may be a suitable technique (under vigilant monitoring) to repair thoracic aortic aneurysms in older patients with low cardiac function.