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Chronic Total Occlusion of the Left Main and Severe Aortic Stenosis

Silvia Maiani1, Francesco Sanna2, Alberto Boi2

  • 1Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Monserrato, Italy.

JACC. Case Reports
|August 19, 2024
PubMed

Insights

Elderly patients with severe aortic stenosis and coronary artery disease can safely undergo transcatheter aortic valve replacement. This minimally invasive procedure is feasible for complex cases involving left main chronic total occlusion.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Medicine

Background:

  • Elderly patients frequently present with concomitant severe aortic stenosis and coronary artery disease, posing therapeutic challenges.
  • Optimal management strategies for this complex patient cohort remain under investigation.
  • Left main coronary artery chronic total occlusion (CTO) adds significant complexity to treatment decisions.

Observation:

  • Two challenging cases involving elderly patients with severe aortic stenosis and left main CTO are presented.
  • These patients underwent transcatheter aortic valve replacement (TAVR).

Findings:

  • Transcatheter aortic valve replacement (TAVR) was demonstrated to be safe and feasible in these complex cases.
  • Both balloon-expandable and self-expanding TAVR systems were successfully utilized.
  • The procedures effectively addressed both severe aortic stenosis and the challenges posed by left main CTO.

Implications:

  • TAVR offers a viable and safe treatment option for elderly patients with severe aortic stenosis and complex coronary artery disease, including left main CTO.
  • These findings support the consideration of TAVR in high-risk elderly patients with combined valvular and coronary pathology.
  • Further research may explore expanded indications and long-term outcomes of TAVR in this specific population.

Keywords:
aortic stenosischronic total occlusioncoronary artery diseaseleft maintranscatheter heart valve implantation

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