[Anesthesia for Transcatheter Aortic Valve Implantation and Off-pump Coronary Artery Bypass Grafting in a Patient with Total Occlusion of Right Common Carotid Artery].

Transcatheter aortic valve implantation (TAVI) is a novel treatment option for inoperative high-risk pa- tients with severe aortic stenosis (AS). However, there is a risk of cerebral ischemia by the two times of rapid ventricular pacing (RVP) procedure during valvulo- plasty and prosthesis implantation. An 86-year-old man was diagnosed with old myocardial infarction and severe AS, and was scheduled to undergo TAVI and off-pump coronary artery bypass grafting (OPCAB). He had the risk of cerebral ischemia due to total occlu- sion of the right common carotid artery, and was monitored with bilateral bispectral index (BIS) and cerebral regional saturation of oxygen (rSO2). In order to maintain his cerebral blood flow, we used low dose catecholamine during OPCAB. During prosthesis implantation, RVP was performed as quickly as pos- sible to maintain cerebral perfusion. Hemodynamics of the patient was restored with no reduction of either bilateral BIS or rSO2 values after RVP. He did not develop neurological complications and was discharged on postoperative day 15. Rapid ventricular pacing followed by unstable hemo- dynamics during valvuloplasty and prosthesis implan- tation is challenging to the anesthesiologists.