부산대학교 도서관

Background Severe aortic stenosis (AS) and coronary artery disease (CAD) often coexist since they both share the same risk factors and pathophysiology. Patients with severe AS with prohibitive surgical risk are often treated with transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) as a staged or concurrent procedure. Significant calcified CAD and left ventricular (LV) systolic impairment in such patients would add more challenges to the management. A clear consensus on the timing of revascularization of such patients in relation to the TAVI procedure is lacking. Case summary Herein, we present an 86-year-old male who presented to a local district hospital with non-ST-segment elevation myocardial infarction (N-STEMI) and decompensated heart failure. His transthoracic echocardiography showed moderate LV systolic impairment with low-flow severe AS. He was initially treated with dual anti-platelet and diuretic therapy and subsequently underwent coronary angiography that revealed severe calcified shelf-like left main stem (LMS) and moderate left anterior descending (LAD) disease. He was successfully treated with TAVI and rotational atherectomy (RA)- assisted PCI to LMS and LAD in the same setting. Conclusion There is limited evidence on effective strategies to tackle high-risk angioplasty with concurrent TAVI in patients with impaired LV function. We performed TAVI and RA to LMS and LAD in the same setting using no mechanical circulatory support (MCS). Management strategies should be individualized to highly selected patients taking into account LMS involvement, calcium modulation strategies, haemodynamic instability, or cardiogenic shock and whether MCS is needed. Keywords Left main stem * Percutaneous coronary intervention * Rotational atherectomy * Severe aortic stenosis * Transcatheter aortic valve implantation * Impaired left ventricular function * Case report ESC Curriculum 3.1 Coronary artery disease * 3.2 Acute coronary syndrome * 3.4 Coronary angiography * 4.2 Aortic stenosis * 6.4 Acute heart failure
Introduction There is limited evidence to support rotational atherectomy (RA) of left main stem (LMS) disease during transcatheter aortic valve implantation (TAVI). Transcatheter aortic valve implantation has expanded as an [...]