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Dawn of a new era: the completely interventionally treated patient
Alexander Kypta1, Hermann Blessberger2, Michael Lichtenauer3
1Cardiovascular Division, General and University Teaching Hospital Linz, Linz, Austria.
Insights
A frail elderly patient underwent successful simultaneous treatment for severe aortic stenosis and coronary artery disease. Later, a leadless pacemaker was implanted to manage atrioventricular-block, demonstrating effective multi-procedural care.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- A 75-year-old female patient presented with atrial fibrillation and angina pectoris.
- Severe aortic valve stenosis and significant coronary artery stenoses were diagnosed.
- The patient's frailty and comorbidities presented complex treatment challenges.
Observation:
- The patient underwent successful implantation of two drug-eluting stents in the left anterior descending and circumflex arteries.
- A 23 mm Core Valve bioprosthesis was implanted without complications during the same session.
- Following discharge, the patient developed symptomatic complete atrioventricular-block with a slow escape rhythm.
Findings:
- A leadless pacemaker (Micra) was successfully implanted via transvenous transfemoral access.
- The dual-intervention approach for valvular and coronary disease was completed in one session.
- Management of post-procedural atrioventricular-block was achieved with a minimally invasive pacing solution.
Implications:
- This case highlights the feasibility of a combined interventional strategy for severe aortic stenosis and coronary artery disease in frail patients.
- The successful implantation of a leadless pacemaker addresses conduction abnormalities post-procedure, improving patient outcomes.
- This integrated approach may offer a streamlined and effective treatment pathway for complex cardiac conditions.
Abstract:
A frail 75-year-old woman with permanent atrial fibrillation and angina pectoris was admitted to our department for further evaluation. Echocardiography revealed concurrent severe aortic valve stenosis. Furthermore, significant coronary artery stenoses were identified on the coronary angiogram. We chose the following treatment strategy: first, two drug eluting stents were implanted successfully in the left anterior descending and circumflex artery, respectively. Second, a 23 mm Core Valve bioprosthesis (Medtronic Inc, Minneapolis, Minnesota, USA) was implanted without complications within the same session. Two weeks after hospital discharge, the patient showed up at our outpatient department, with a symptomatic complete atrioventricular-block with an escape rhythm of 35 bpm. Thus, finally, a leadless pacemaker Micra (Medtronic Inc) was implanted via a transvenous transfemoral access without any complications.
