This study aimed to compare the hemodynamic effects of two analgosedation regimens, Remifentanil/Propofol vs. Dexmedetomidine/Propofol, during transfemoral transcatheter aortic valve implantation (tf-TAVI).
In this monocentric, prospective, non-randomized observational study, 143 patients undergoing tf-TAVI between November 2021 and November 2023 were analyzed. Patients received either Remifentanil/Propofol or Dexmedetomidine/Propofol as part of their standard sedation regimen. A sensitivity analysis using propensity score matching was performed to support the primary analysis.
The primary outcome was circulatory stability, assessed by the need for catecholamines to maintain a mean arterial pressure (MAP) of 65 mmHg. Catecholamine use was significantly higher in the Dexmedetomidine group (78% vs. 55%; p = 0.012). No significant differences were observed in major post-procedural complications (Remifentanil: 19.05% vs. Dexmedetomidine: 13.56%; p = 0.389) or postoperative delirium scores. However, intraoperative agitation, defined as observed procedure disruption, was significantly less frequent in the Remifentanil group (33% vs. 69%; p = 0.01). Propensity score matching confirmed the robustness of these findings.
In conclusion, both sedation strategies were associated with comparable overall clinical outcomes in patients undergoing tf-TAVI. However, our findings suggest that a tailored sedation approach may be warranted: Remifentanil–Propofol may be preferable in patients with fragile hemodynamics, whereas dexmedetomidine–propofol may represent a safer option in patients at risk for respiratory compromise. These observations support an individualized, patient-centered sedation strategy rather than a one-size-fits-all approach.
Bicuspid aortic valve-associated infective endocarditis (BAV-IE) is a unique and aggressive type of native valve infection. The combined effects of congenital valve malformation, altered hemodynamics, and genetic susceptibility promote endothelial injury and bacterial colonization, predisposing affected individuals to serious infections. Compared with endocarditis in the tricuspid aortic valve, BAV-IE affects young patients with few comorbidities and causes more severe tissue damage, periannular abscesses, and necessitates early surgery. Notably, streptococci and staphylococci remain the predominant pathogens causing the disease. Multimodal imaging, which integrates transthoracic and transesophageal echocardiography into cardiac computed tomography, is crucial for the early detection of structural complications and surgical planning. Prompt surgical interventions, including radical debridement, valve replacement, and appropriate aortic repair, ensure optimal infection control and long-term outcomes. Moreover, long-term survival is favorable, regardless of infection severity, when managed promptly and comprehensively. Lifelong surveillance and preventive strategies focusing on oral hygiene, infection control, and procedural asepsis are critical for reducing recurrence and improving prognoses in this high-risk population.
Lipomatous hypertrophy of the interatrial septum is rare, and extension to surrounding structures is extremely uncommon, yet may result in obstructive symptoms requiring surgical resection.
This case report describes a 56-year-old male who had been undergoing an outpatient workup for lightheadedness, palpitations, and chest pain. Computed tomography revealed a large mass extending from the superior vena cava to the atrial septum, resulting in compression of the superior vena cava. Magnetic resonance imaging suggested lipomatous characteristics. Subsequently, the patient was referred for cardiac surgery and underwent an uncomplicated resection of the mass and reconstruction of the superior vena cava, with ensuing resolution of the symptoms.
Lipomatous hypertrophy of the interatrial septum can rarely expand into the superior vena cava, causing obstructive symptoms. Symptomatic relief may be achieved via resection of the entire mass, which can be performed without violating the atrial septum and atrial wall.