Transcatheter aortic valve implantation in an elderly man with severe aortic stenosis and high surgical risk.

An 85-year-old man with severe aortic stenosis (transaortic peak velocity 4.4 m/s, mean gradient 46 mmHg and valve area 0.71 cm(2)) was admitted to our hospital due to mild exertional dyspnea (NYHA class II). He had received low-dose prednisolone (5 mg/day) plus tacrolimus hydrate (1.5 mg/day) for rheumatic arthritis and interstitial pneumonia. Although aortic valve replacement was indicated, he was considered at high risk to undergo open heart surgery because of reduced pulmonary function (FEV1.0%, 77.2%) and long-term treatment with immunosuppressive drugs. After a multidisciplinary heart team conference, the decision was made to perform transfemoral transcatheter aortic valve implantation (TAVI) using a SAPIEN XT 26 mm valve. TAVI was completed in 105 minutes without any complications. After the procedure, his symptom was improved and his activity of daily life was maintained, and he was ambulatory the next day. Aortic stenosis by degenerative calcification is becoming increasingly common as the Japanese population ages. TAVI has been used to treat patients with concomitant diseases and at high risk of open heart surgery. We herein report a case with rheumatic arthritis and interstitial pneumonia that underwent successful TAVI.