Left Main Coronary Occlusion During TAVI Procedure: Calcium Embolization Matters

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Acute coronary occlusion is a rare but life-threatening complication during transcatheter aortic valve implantation (TAVI).
• Pre-procedural multidetector computed tomography (MDCT) assesses anatomical risks, but occlusion can still occur due to emboli or other mechanisms.
• Sudden hemodynamic collapse during TAVI necessitates prompt recognition and intervention for potential coronary occlusion.

Purpose of the Study:

• To report a case of acute coronary occlusion during TAVI in a patient with seemingly low anatomical risk.
• To describe the successful management of this complication using emergent percutaneous coronary intervention (PCI).
• To emphasize the importance of prompt diagnosis and intervention for coronary occlusion during TAVI.

Main Methods:

• A case report detailing a TAVI procedure complicated by acute coronary occlusion.
• Diagnostic workup including hemodynamic monitoring and coronary angiography.
• Therapeutic intervention with emergent left main (LM) bifurcation PCI.

Main Results:

• The patient experienced sudden hemodynamic collapse during TAVI, raising suspicion for coronary occlusion.
• Coronary angiography revealed acute occlusion at the left main bifurcation.
• Successful salvage with emergent LM bifurcation PCI was achieved, stabilizing the patient.

Conclusions:

• Acute coronary occlusion can occur during TAVI even in patients without apparent high-risk anatomical features.
• Prompt recognition and emergent PCI, particularly for left main bifurcation involvement, are critical for patient survival.
• This case underscores the need for vigilance and preparedness for coronary complications during TAVI procedures.