Staged High-Risk Percutaneous Coronary Intervention with Impella Support after On-Pump Transcatheter Aortic Valve...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Concomitant severe aortic stenosis and obstructive coronary artery disease pose management challenges, especially in patients at high surgical risk.
• Current practice often favors percutaneous coronary intervention before transcatheter aortic valve replacement (TAVR), but sequential procedures are being explored.
• Optimal timing for revascularization in relation to TAVR remains an evolving area of clinical practice.

Observation:

• A 90-year-old male with multivessel coronary artery disease and severe aortic stenosis, deemed at prohibitive surgical risk, was treated.
• The patient underwent transcatheter aortic valve replacement (TAVR) with hemodynamic support.
• Following TAVR, Impella-assisted percutaneous coronary intervention was performed on the unprotected left main coronary artery.

Findings:

• This case highlights the feasibility of performing percutaneous coronary intervention after transcatheter aortic valve replacement in a complex patient.
• The sequential approach, TAVR followed by PCI, was successfully executed with hemodynamic support and Impella assistance.
• The procedure addressed both severe aortic stenosis and multivessel coronary artery disease in a patient unsuitable for traditional surgery.

Implications:

• Performing percutaneous coronary intervention after TAVR may be a viable strategy for select high-risk patients with complex coronary anatomy.
• This approach could expand treatment options for patients with combined aortic stenosis and coronary artery disease who are poor surgical candidates.
• Further research and case studies are needed to establish the safety and efficacy of post-TAVR PCI strategies.