A sentrant sheath was used as a conduit for an medtronic bioprosthetic valve.It was noted the iliofemoral artery was calcified with a small diameter.It was reported during the index procedure after deployment of the valve angiogram identified a dissection of the left femoral artery with occlusion of the profunda.2 additional covered stents 7x5 mm and 7x6 mm) were implanted.Post-operative hemoglobin was noted as 8.7.(13.1 pre-op).The following day a chest x-ray showed atelectasis and/or an effusion.In addition, the femoral artery dissection caused significant bleeding.Two days following the valve implant, a computed tomography revealed a large anterior left thigh hematoma.An echocardiogram noted an estimated ejection fraction of 60-65% with impaired relaxation pattern of the left ventricular diastolic filling.Dry-heaving presented which resolved with medication.Lower extremities were auscultated via doppler.Abdomen and left groin pain presented.Sinus tachycardia was observed at a rate of 180 beats per minute but this quickly resolved.Intravenous therapy fluids were administered.Changes in pallor, weakness, and urine concentration were reported.The patient was transferred to an intensive care unit.Endotracheal intubation, a pulmonary catheter, and a blood transfusion of four units, were required.Cardiopulmonary arrest and sub sequent cardiogenic shock occurred.Ultimately, the patient died three days after the valve implant procedure.An autopsy will not be performed.Were administered.Changes in pallor, weakness, and urine concentration were reported.The patient was transferred to an intensive care unit.Endotracheal intubation, a pulmonary catheter, and a blood transfusion of 3 units, were required.Cardiopulmonary arrest and subsequent cardiogenic shock occurred.Ultimately, the patient died three days after the valve implant procedure on (b)(6) 2022.Per the site the dissection at the iliac artery occurred as a result of advancement of the dcs through the small (6.1 mm), calcified vessel or advancement of the external sheath.It was reported that difficulty was experienced when advancing the dcs.The occlusion at the common femoral artery occurred as a result of deployment of the closure devices in soft plaque.The death was considered procedure related.No additional clinical sequelae were reported and the patient expired.
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