bivalirudin and Aortic-Valve-Insufficiency

Bivalirudin is an accepted alternative to heparin for anticoagulation during select cardiac procedures. Its use has not been well described during transcatheter aortic valve replacement. Herein is the report of a transcatheter valve replacement case that was complicated by catastrophe and need for emergent cardiopulmonary bypass. A successful outcome was achieved. However, the inability to rapidly reverse the anticoagulation effect of bivalirudin proved troublesome, and that provides for a cautionary tale about its use during transcatheter valve replacement.

Topics: Aged, 80 and over; Anticoagulants; Aortic Valve Insufficiency; Aortic Valve Stenosis; Cardiopulmonary Bypass; Dose-Response Relationship, Drug; Heart Valve Prosthesis; Hirudins; Humans; Male; Peptide Fragments; Recombinant Proteins; Transcatheter Aortic Valve Replacement

Topics: Anesthetics, Intravenous; Anticoagulants; Aortic Valve Insufficiency; Cardiopulmonary Bypass; Heart Valve Prosthesis Implantation; Heparin; Hirudins; Humans; Infusions, Intravenous; Liver Cirrhosis; Male; Middle Aged; Peptide Fragments; Propofol; Recombinant Proteins; Renal Insufficiency; Sufentanil; Thrombocytopenia; Whole Blood Coagulation Time