Balloon aortic valvuloplasty (BAV) is a treatment for high risk patients with severe aortic valve stenosis (AS). Rapid pacing is needed to reduce cardiac output when dilating the balloon, but it may cause cardiac ischemia or lethal arrhythmia. In this case report, percutaneous cardiopulmonary support (PCPS) was used to prevent these complications with BAV. We achieved adequate blood pressure and cardiac output during BAV without using rapid pacing by drawing a certain amount of blood into the reservoir equipped with the PCPS circuit. When performing BAV, PCPS may be a useful option for the patients who have high risks of circulatory failure.

A 25-year-old man with a previous diagnosis of congenital bicuspid aortic valve presented with a fever of unknown origin for 3 months. Transthoracic echocardiography revealed vegetation on the mitral valve leaflet. Transesohageal echocardiography revealed severe aortic regurgitation and a mitral valve leaflet aneurysm. Despite intensive antibiotic therapy, his clinical condition did not improve, so he underwent aortic and mitral valve repair. The aortic valve was shown to be unicuspid intraoperatively. We made a new commissure, then mitral valve aneurysm was resected and a new leaflet was made using the pericardium. There was almost no regurgitation seen on postoperative echocardiography.

Objective: This study aimed to examine the background and outcomes of transcatheter aortic valve replacement (TAVR) in patients with low-risk scores. Methods: We retrospectively reviewed 69 patients with risk scores of<4% undergoing TAVR in a single institution from January 2016 through June 2021. Results: The mean age of the patients was 81±4.5 years, and 52% of them were women. The reasons for TAVR selection included very old age (≥85 years; 20%); frailty (51%); ascending aortic calcification (4.3%); history of mediastinal radiation therapy (2.8%); and respiratory diseases (10%). Six patients required early discharge and recovery for another surgery following treatment of aortic stenosis or family members' care, and 2 patients had an estimated life expectancy of 1-5 years. Also, three patients strongly desired TAVR despite having none of the objective factors that favor TAVR. The median lengths of stay in the ICU and after TAVR were 1 day (1-11 days) and 5 days (3-40 days). There was neither operative mortality nor a need for aortic valve reintervention. Kaplan-Meier curves showed that the one-year survival rate was 99%, and two-year and three-year survival rates were 97% each. The causes of late death were sepsis, unknown factor, and intracranial hemorrhage. Discussion: The short-term and medium-term outcomes of TAVR with low-risk score patients were favorable although the patient background was poor due to high-risk factors for surgery that were excluded from the risk scores.