Anand Mehta

Single center TAVR experience with a focus on the prevention and management of catastrophic complications

Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis (AS) who are inoperable or at high risk for complications with surgical aortic valve replacement. We report here our single‐center data on consecutive patients undergoing transfemoral (TF) TAVR since the inception of our program, with a special focus on minimizing and managing complications.

Complete Aortic Valve Fusion After HeartMate II Left Ventricular Assist Device Support

HEART FAILURE affects millions of people, costs billions of dollars, and at the end-stage level is curative only hrough heart transplant and only for those who meet the riteria. By paralleling the function of the heart, mechanical upport devices provide another tool in the management of eart failure.1 The first generation of ventricular assist devices included the Thoratec PVAD (Thoratec Corp, Pleasanton, CA) and the Heartmate I (Thoratec Corp); they provided a new avenue for the treatment of heart failure but left much to be desired. The second generation of ventricular assist devices, such as the HeartMate II (Thoratec Corp) and the Jarvik 2000 (Jarvik Research Inc, New York, NY), provided improvements over the first generation; however, there is a great deal that is not known about the consequences of their implantation, particularly for longer lengths of time. The authors present a case of heart failure treated by left ventricular assist device (LVAD) implantation that resulted in complete aortic valve fusion.

Transvenous lead extraction: A clinical commentary for Anesthesiologists

With increasing use of cardiovascular implantable electronic devices, the need for lead extractions has increased to an annual volume of more than 10,000 extractions worldwide. This article provides a focused clinical commentary on the perioperative management, identification, and treatment of life-threatening complications associated with lead extractions. In addition, a summary of indications, techniques, and lead extraction complications is provided. Although uncommon, lead extractions are associated with a consistent rate of major procedure-related complications and mortality. Major life-threatening complications include vascular laceration, cardiac avulsion, hemothorax, pericardial effusion, and cardiac arrest. Comprehensive preoperative risk assessment and adequate planning and preparedness are crucial to decreasing all procedure-related adverse events. The location of the procedure (electrophysiology suite v hybrid operating room) and the nature of cardiac surgical backup are determined after meticulous risk stratification. In addition to decisions on vascular access, invasive monitoring, and modality of rhythm support, transesophageal echocardiography plays a crucial role in early diagnosis, timely management, and potential prevention of these complications.

Optimizing hemodynamics of transcatheter aortic valve‐in‐valve implantation in 19‐mm surgical aortic prostheses

To demonstrate the feasibility of achieving good hemodynamic results with valve‐in‐valve transcatheter aortic valve replacement (ViV TAVR) for degenerated 19 mm surgical bioprosthetic valves.

Clinical and procedural outcomes with the SAPIEN 3 versus the SAPIEN XT prosthetic valves in transcatheter aortic valve replacement: A systematic review and meta-analysis

The SAPIEN 3 valve (S3V) was designed to overcome the shortcomings of its predecessor, the SAPIEN XT (SXT) valve. We conducted a meta‐analysis to compare their clinical outcomes and procedural characteristics.

A Rare Case of Anomalous Left Coronary Artery From the Pulmonary Artery (Bland-White-Garland Syndrome) in a 68-Year-Old Woman:

Anomalous left coronary artery from the pulmonary artery (ALCAPA), or Bland-White-Garland syndrome, is a rare congenital coronary anomaly that results in altered myocardial perfusion and a left to right shunt. It occurs in 1:300000 live births and represents 0.24% to 0.46% of all congenital cardiac diseases. Despite its rarity, it is one of the most common causes of ischemia and infarction in children. Ninety percent of these patients will die within the first year of life if untreated and diagnosing this abnormality in adulthood is extremely rare. Of those patients who survive to adulthood, the average age of sudden cardiac death is 35 years. The initial symptoms of the adult presentation vary widely from progressive dyspnea to sudden cardiac death; therefore, immediate surgical correction is highly recommended upon diagnosis. Understanding the pathophysiology and nature of collateral coronary flow in this congenital anomaly is paramount to the safe anesthetic management of adults with ALCAPA. Here we describe the intraoperative management and echocardiographic findings in a 68-year-old with with recently diagnosed ALCAPA undergoing surgical repair.

Transapical Ablation of Symptomatic Premature Ventricular Contractions in a Patient with Mechanical Mitral and Aortic Valves

PREMATURE VENTRICULAR COMPLEXES (PVCs) can occur in up to 80% of patients after cardiac surgery. Although the majority of these ventricular arrhythmias are benign, PVCs rarely can become symptomatic or lead to fatal ventricular arrhythmias or PVC-mediated cardiomyopathy. When ablation is required, catheters typically are advanced into the left ventricle in a retrograde fashion via the arterial system or anterograde via a trans-septal approach. This report describes a case of transapical PVC ablation due to the presence of mechanical aortic and mitral valves and its unique anesthetic considerations. Written informed consent was obtained for publication of this case report.