Successful transcatheter aortic valve implantation in a Jehovah's Witness patient with a small aortic root and severe leaflet calcification.

A 69-year-old female Jehovah's Witness was diagnosed with symptomatic severe aortic stenosis (AS). Because the patient, who refused blood transfusion for religious reasons, had multiple comorbidities, such as thrombocytopenia due to liver cirrhosis, esophageal varices, and an old cerebral infarction, a decision to perform transcatheter aortic valve implantation (TAVI) was made. Preprocedural computed tomography showed a small aortic root and severe leaflet calcification, especially at the non-coronary cusp; therefore, the risk of annulus and Valsalva rupture was considered to be high. A 20-mm transcatheter heart valve (Edwards SAPIEN3; Edwards Lifesciences Corporation, Irvine, CA, USA) was successfully implanted using the transfemoral approach. To prevent blood transfusion, erythropoietin and sodium ferrous citrate were prescribed during the periprocedural period. The postprocedural course was uneventful, and the patient was discharged on postoperative day 10. TAVI, which is associated with a significantly lower need for transfusion compared with surgical aortic valve replacement, has recently been performed as a less invasive treatment for high- or intermediate-risk patients with AS. This case highlights the feasibility and safety of TAVI using a 20-mm transcatheter heart valve for a patient with severe AS, a small aortic root, and severe and eccentric leaflet calcification who refused blood transfusion. <Learning objective: Transcatheter aortic valve implantation is a less invasive procedure and is possibly the optimal treatment for patients with severe aortic stenosis who refuse blood transfusion. In addition, periprocedural approaches that promote a high preprocedural hemoglobin level as well as prevent unnecessary blood loss and catastrophic complications are important in avoiding blood transfusions.>.