Evidence map›Paper›PMID 42524791›Full record

ArticleJACC. Case reports2026

Protamine-Exacerbated Right Ventricular Failure After TAVR in Critical Aortic Stenosis.

Jaideep Menda, Jiun-Ruey Hu, Christy Slingwine, Sabah Skaf, Meshe Chonde, Wen Cheng, Suhail Dohad, Raj R Makkar, Tarun Chakravarty

Abstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Jaideep MendaSmidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Jiun-Ruey HuSmidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Christy SlingwineDepartment of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Sabah SkafSmidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Meshe ChondeSmidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Wen ChengSmidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Suhail DohadSmidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Raj R MakkarSmidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Tarun ChakravartySmidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. Electronic address: tarun.chakravarty@cshs.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundProtamine is routinely administered for heparin reversal after transcatheter aortic valve replacement (TAVR), but protamine reaction is an under-recognized and potentially catastrophic complication. CASE SUMMARY: A 79-year-old man with critical aortic stenosis, baseline severe right ventricular (RV) dysfunction, and 2-vessel coronary artery disease underwent TAVR. Immediately following protamine administration for heparin reversal, he developed abrupt hemodynamic collapse with acute RV pressure overload on echocardiography requiring cardiopulmonary resuscitation. Despite inhaled nitric oxide, inotropes, and intra-aortic balloon pump, he remained hypotensive. Insertion of Impella RP resulted in immediate improvement in hemodynamics, with drop in central venous pressure from 31 to 20 mm Hg and improvement in oxygenation and RV contractility. DISCUSSION: Early initiation of RV support with Impella RP should be considered in patients with acute RV failure secondary to protamine reaction. TAKE-HOME MESSAGE: Patients with preexisting RV dysfunction may be susceptible to catastrophic type III protamine reaction because of limited physiologic reserve.

Indexed as

protamineright ventriclestructural interventiontranscatheter aortic valve replacement

Identifiers

PMID42524791
PMCPMC13571334

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.