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Simultaneous Transcatheter Aortic Valve Replacement and Percutaneous Coronary Intervention Under ECMO Support
Xiao-Lin Yu1, Jing-Ya Wang1, Xiang-Yu Dong1
1Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China; Xinjiang Key Laboratory of Cardiovascular Homeostasis and Regeneration Research, Urumqi, China.
Insights
For patients with severe aortic stenosis and complex coronary artery disease, a single-session transcatheter aortic valve replacement plus percutaneous coronary intervention supported by extracorporeal membrane oxygenation is a feasible and potentially life-saving strategy.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Severe aortic stenosis (AS) frequently coexists with coronary artery disease (CAD).
- Optimal timing for percutaneous coronary intervention (PCI) in AS patients, particularly high-risk individuals, remains uncertain.
Background:
Patients with severe aortic stenosis (AS) often have concomitant coronary artery disease (CAD), but optimal timing of percutaneous coronary intervention (PCI) remains unclear, especially in those with very high risk.
Case Summary:
A 63-year-old man with severe AS (aortic valve area 0.9 cm2), reduced left ventricular ejection fraction (40%), and triple-vessel CAD including bilateral chronic total occlusions underwent a single-session transcatheter aortic valve replacement (TAVR) plus PCI under prophylactic veno-arterial extracorporeal membrane oxygenation because of extreme risk of hemodynamic collapse. TAVR was performed first, followed by rotational atherectomy-assisted PCI.
Discussion:
Prophylactic veno-arterial extracorporeal membrane oxygenation provided a critical safety net, allowing valve recapture and repositioning despite heavy calcification and successful chronic total occlusion revascularization. This 1-stop strategy avoided staged procedures and cumulative cardiac stress.
Take-Home Message:
For high-risk AS with complex CAD, a 1-stop TAVR-plus-PCI strategy under prophylactic ECMO support is feasible and potentially life-saving; careful imaging and advanced intraoperative techniques are essential.
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