Is transfemoral aortic valve implantation possible without contrast medium in patients with renal and multiorgan failure?

Transfemoral aortic valve implantation has recently emerged as a therapeutic option for patients with symptomatic, severe aortic stenosis for whom standard surgical aortic valve surgery is not suitable. Aortic valvuloplasty and valve positioning is normally performed under fluoroscopy and requires several injections of contrast medium. In critically ill patients with advanced renal insufficiency, contrast media administration can further increase renal damage; therefore, an echocardiogram and fluoroscopy-guided procedure, using the calcified contours of the stenotic aortic valve as a landmark may be a useful alternative. We report the first successful transfemoral aortic valve implantation procedure performed under fluoroscopy and transesophageal echocardiogram control, without administration of contrast medium injections in a patient with severe renal insufficiency and multiorgan failure.