To describe a case of spinal cord infarct after transcatheter aortic valve replacement (TARV)

Spinal cord infarct is a well-known complication of thoracoabdominal aneurysms open repair, with an approximate incidence of 8%. TARV is a frequently used option for high-risk surgical patients with severe aortic stenosis. Because the descending aorta is not involved in TARV, post procedure spinal cord infarct is considered rare. We report a case of infarct of the thoracic and lumbar spinal cord after TARV.

Case report

68-year-old male with history of heart failure, end stage kidney disease (ESRD), coronary artery bypass, and renal cell carcinoma was electively admitted for TARV for severe aortic stenosis. CT angiogram (CTA) of abdomen revealed severe calcified atherosclerotic disease throughout the entire vascular system from the distal abdominal aorta to toes. TARV procedure lasted about 30 minutes with no significant reported blood loss. Immediately after, he reported severe low back pain and inability to move his legs. Bladder control was unclear (ESRD), and bowel function was preserved. On exam, sensation to light touch was preserved throughout, strength was preserved in upper extremities, but absent in lower extremities. His patellar, Achilles and plantar reflexes were absent. Magnetic resonance imaging (MRI) of spine revealed diffuse long segment signal abnormality and mild edema involving the distal thoracic spinal cord extending into the conus consistent with spinal cord infarct. The patient remained paraplegic at discharge.