TAVI in Elderly Patient with COPD

An 88-year-old woman is scheduled for an elective transcatheter aortic valve implantation (TAVI). Her aortic stenosis has been under surveillance since she underwent two-vessel coronary bypass grafting nine years ago. She has experienced worsening exertional dyspnoea (NYHA III) and orthopnoea over the past six months and had an admission for heart failure last month that responded to diuretics. She is an ex-smoker (30 pack-year history) with moderate chronic obstructive pulmonary disease. Her current FEV1 is 1.2 litres (56% predicted). She had one admission for a respiratory illness in 2021 when she experienced COVID-19 pneumonitis. Medications: Amlodipine 5 mg mane Aspirin 100 mg mane Pantoprazole 20 mg mane Ramipril 5 mg mane Symbicort Turbuhaler (budesonide/formoterol) 200/6 mcg 2 puffs inhaled bd Salbutamol inhaled prn Biometrics: Height 178 cm Weight 58 kg Body mass index 18.3 kg/m2 Body surface area 1.73 m2