Pancreaticoduodenectomy after transcatheter aortic valve implantation in an elderly patient with severe aortic stenosis and pancreas cancer: A case report
| Autor: | Kensuke Nuruki, Teruo Komakata, Nobuhiro Tada, Tamahiro Kinjo, Ryo Imada, Bibek Aryal, Tetsuro Kataoka, Kosuke Mukaihara, Kiyohisa Hiramine |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
CPB Cardiopulmonary bypass medicine.medical_treatment Case Report PD Pancreaticoduodenectomy Malignancy Pancreaticoduodenectomy 03 medical and health sciences 0302 clinical medicine AS Aortic stenosis Aortic valve replacement Pancreatic cancer Adjuvant therapy medicine DAPT dual antiplatelet therapy Pancreatic head cancer Transcatheter aortic valve implantation SAVR Surgical aortic valve replacement business.industry Aortic stenosis Standard treatment General Medicine Perioperative medicine.disease CT computed tomography Surgery Stenosis 030220 oncology & carcinogenesis TAVI Transcatheter aortic valve implantation 030211 gastroenterology & hepatology business |
| Zdroj: | Annals of Medicine and Surgery |
| ISSN: | 2049-0801 |
| DOI: | 10.1016/j.amsu.2021.01.050 |
| Popis: | Introduction and importance Not only pancreatic cancer but also aortic stenosis (AS) is increasing with the aging population. There is no optimal strategy for elderly patients with both pancreatic cancer and AS. We report a case of pancreatic head cancer with severe AS undergoing pancreaticoduodenectomy (PD) after transcatheter aortic valve implantation (TAVI). Case presentation An 88-year-old woman was referred to our hospital because of severe AS with symptoms of heart failure. Preoperative examination revealed resectable pancreatic head cancer, so TAVI was performed before PD to reduce the perioperative risk. The patient underwent PD 34 days after TAVI, with no significant postoperative complications, and was transferred to the other hospital for rehabilitation on postoperative day 45. No recurrence was observed at more than 7 months without adjuvant therapy. Clinical discussion Aortic valve replacement (AVR) is recommended before non-cardiac surgery in patients with symptomatic severe AS. Surgical aortic valve replacement (SAVR) is the standard treatment. However, owing to the highly invasive procedure and increased perioperative risk, SAVR is usually avoided in elderly patients with malignancy and severe AS. We demonstrated that TAVI followed by PD could be safely performed in high-risk elderly patients presenting with both severe AS and pancreatic head cancer. To our knowledge, this is the first case report of PD after TAVI in a patient with severe AS. Conclusion We demonstrated that TAVI followed by PD could be safely performed in high-risk elderly patients presenting with severe AS and co-existing malignancy. Highlights • Severe aortic stenosis (AS) is a risk factor for non-cardiac surgery. In some cases, prior treatment of AS is recommended. • Minimally invasive transcatheter aortic valve implantation (TAVI) may be a treatment option for the elderly cancer patients. • Preceding TAVI may be a useful therapeutic strategy for elderly cancer patients with severe AS. |
| Databáze: | OpenAIRE |
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