Emergent Percutaneous Biventricular Support during Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Coronary obstruction is a rare but serious complication following transcatheter aortic valve replacement (TAVR).
• Hemodynamic collapse during high-risk percutaneous coronary intervention in TAVR patients necessitates temporary circulatory support.
• The Edwards SAPIEN prosthesis is a common choice for TAVR procedures.

Observation:

• A patient undergoing TAVR with the Edwards SAPIEN prosthesis developed coronary obstruction.
• The patient experienced hemodynamic collapse during a subsequent high-risk percutaneous coronary intervention.
• Emergent percutaneous biventricular support was initiated.

Findings:

• Percutaneous biventricular support, utilizing the Tandem Heart for right ventricular support and Impella CP for left ventricular support, was successfully implemented.
• This dual mechanical circulatory support served as a bridge to recovery for the patient.
• The case demonstrates a novel approach to managing a dreaded TAVR complication.

Implications:

• Emergent biventricular mechanical circulatory support can be a life-saving strategy in rare TAVR-related coronary obstruction scenarios.
• This case expands the armamentarium for managing complex TAVR complications.
• Further research into the optimal use of biventricular support in TAVR complications is warranted.