Authors: Choi et al.
Cureus 17(8): e89552. doi:10.7759/cureus.89552, August 07, 2025
Summary
This case report describes anesthetic management for an 85-year-old man undergoing valve-in-valve transcatheter aortic valve replacement (TAVR) after failure of his primary TAVR. The redo procedure carried compounded hemodynamic and neurologic risks. General anesthesia with etomidate, fentanyl, low-dose propofol, and remifentanil provided cardiovascular stability, while proactive epinephrine and norepinephrine strategies countered rapid pacing-induced hypotension. Continuous transesophageal echocardiography and cerebral oximetry guided valve deployment and neuroprotection. The patient was extubated in the hybrid suite, required minimal vasoactive support, ambulated on postoperative day one, and was discharged home on day two.
What You Should Know
• Redo valve-in-valve TAVR, though rare, is increasingly relevant as structural deterioration occurs in earlier implants.
• General anesthesia with gentle induction agents and proactive vasopressors supports stability during rapid ventricular pacing.
• Continuous TEE and cerebral oximetry are essential for real-time hemodynamic and neurologic monitoring.
• A fast-track approach with early extubation and mobilization is feasible, even in frail elderly patients, with careful anesthetic planning.
• Multidisciplinary preparation and individualized anesthetic management are key to safe outcomes.
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