心肺バイパスは、併存するハイリスク経皮的冠動脈インターベンションおよび経カテーテル大動脈弁置換術にとって安全かつ効果的なサポートである

Patients with coexisting severe aortic stenosis (AS) and critical coronary artery disease (CAD) face high procedural risk when treated percutaneously. Although mechanical circulatory support (MCS) can mitigate hemodynamic instability, evidence guiding the use of cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) during concomitant transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) is lacking.

The authors retrospectively reviewed 6 high-risk patients who underwent concomitant TAVR and PCI with planned MCS using CPB or venoarterial (VA)-ECMO between 2015 and 2023. Outcomes were classified according to VARC-3 criteria.

Six male patients (mean age 77.3 ± 8.3 years) underwent concomitant TAVR and PCI with planned MCS using CPB (n = 4, 2015-2020) or VA-ECMO (n = 2, 2022-2023). Complete coronary revascularization was achieved in 4 cases (66.7%). Implanted valves included 2 self-expanding and 4 balloon-expandable prostheses. The mean catheter-measured transaortic gradient decreased from 37.2 ± 17.6 mm Hg to 3.9 ± 2.1 mm Hg (P = .006). Trace (1+) paravalvular leak occurred in 4 patients (66.7%), with none 2+ or higher. There were no intraprocedural complications, neurologic events, major bleeding, vascular complications, or 30-day deaths. Three patients (50%) developed new conduction abnormalities, all without pacemaker requirement. Acute kidney injury occurred in 3 (Stage I, 50%). The mean intensive care and total hospital stays were 5.5 ± 3.5 and 8.3 ± 6.0 days, respectively.

Planned CPB or VA-ECMO support enabled safe performance of concomitant TAVR and PCI in non-surgical, high-risk patients, representing a feasible approach for selected complex cases.