Journal of cardiology cases
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Case Reports
Trans-catheter aortic valve implantation without contrast using the Lotus mechanically-expanded heart valve.
Trans-catheter aortic valve implantation (TAVI) has become an established treatment for inoperable and high-surgical risk patients with severe, symptomatic aortic stenosis (AS). Post-procedural acute kidney injury (AKI) is a frequent complication following TAVI and is associated with increased mortality. Patients with pre-existing chronic renal impairment are at particularly high risk. ⋯ The principal procedural issues are contrast-induced nephropathy and intra-procedural hypotension. Our case report demonstrates how TAVI can be performed with zero contrast and minimization of procedural hypotension, facilitated by the use of trans-esophageal echocardiography and the mechanically-expanded Lotus valve. This approach should only be used in exceptional circumstances, but can be particularly relevant for patients with pre-existing chronic renal impairment, who are at increased risk of post-TAVI AKI.>.