Emergency transcatheter aortic valve implantation with a self-expandable valve under extracorporeal membrane oxygenation for cardiogenic shock due to bicuspid aortic stenosis: a case report.

Background: Transcatheter aortic valve implantation (TAVI) is an established treatment for patients with severe aortic stenosis (AS). However, the effectiveness of TAVI for patients with cardiogenic shock due to severe bicuspid AS, who require mechanical circulatory support, needs further investigation.

Case Summary: A 64-year-old male patient was admitted to the hospital with congestive heart failure secondary to severe AS and severe left ventricular dysfunction. After admission, he developed cardiogenic shock, further worsening his condition. The patient was placed on veno-arterial extracorporeal membrane oxygenation support and an intra-aortic balloon pump and transferred to our hospital. Cardiac computed tomography revealed a severely calcified type 1 bicuspid valve. The patient was deemed inoperable by our heart team. Therefore, an emergency transfemoral TAVI with a self-expandable valve was performed on Day 2. It significantly improved his haemodynamic stability. The patient was finally discharged on Day 29 without any neurological sequelae.

Discussion: Cardiogenic shock due to severe AS has poor prognosis. However, this case report demonstrates that TAVI could be the optimal treatment for haemodynamically unstable patients with severe AS who require mechanical circulatory support.