Kardiogenní šok je hlavní příčinou úmrtí hospitalizovaných nemocných s akutními koronárními syndromy. V současnosti je jediným způsobem léčby s prokázaným přínosem okamžitá revaskularizace, a to buď perkutánní, nebo chirurgická. Přes nedostatek důkazů se k obnově hemodynamické stability -kromě revaskularizace -navíc běžně používá intraaortální balonková kontrapulsace (IABP) a podávají se vasoaktivní látky. Z hlediska hemodynamiky jsou kromě IABP k dispozici ještě účinnější zařízení pro mechanickou podporu oběhu jako např. Impella, TandemHeart a venoarteriální extrakorporální membránová oxygenace (V-A ECMO). Přes absenci prokázaného přínosu z hlediska přežití může uvedená přístrojová technika zachraňovat životy pacientů se závažným zhoršením hemodynamických parametrů na katetrizačním sále. Popisujeme případ hlubokého kardiogenního šoku v důsledku komplikované ischemické choroby srdeční, recidivy zástavy srdce během PCI, zavedení IABP během PCI mezi epizodami zástavy srdce a úspěšné resuscitace pomocí V-A ECMO. Úplné revaskularizace bylo dosaženo po zavedení přístroje pro ECMO; pacient byl propuštěn po 29 dnech bez neurologického postižení a s ejekční frakcí 40 %.

Introduction: Transcatheter aortic valve implantation is a routine clinical method for patients with severe aortic stenosis at high surgical risk, such as previous cardiac surgery. The presence of mechanical mitral prosthesis might complicate trans-catheter aortic valve implantation because of possible interference between both prostheses. Some clinical reports have already demonstrated the feasibility of trans-catheter aortic valve implantation in such patients.

Aortic valve replacement improves survival of cancer patients with symptomatic aortic stenosis. Transcatheter aortic valve replacement (TAVI) is a treatment option in inoperable patients and patients at high surgical risk. Symptoms should not be confused for the progression of the malignant disease. In patient selection emphasis should be made on their frailty and futility. Eligible patients must have a life expectancy of at least 1 year. Final decision has to be made by a multidisciplinary heart team. TAVI can reduce treatment risk and facilitate the oncologic treatment.

Background: Transcatheter aortic valve implantation (TAVI) is a widely used treatment of severe aortic stenosis. Implantation of a self-expanding valve into a dense calcified aortic annulus can be challenging and may result in device malposition and malfunction. Aim: The aim of our case report is to present a novel technique of transcatheter aortic valve dislocation treatment. Case presentation: An 86-year-old woman with severely calcified aortic valve underwent TAVI using a 27-mm self-expanding Portico valve (Abbott Vasc, USA). In the last phase of implantation, the valve dislocated deep into the left ventricular outflow tract resulting in significant paravalvular regurgitation and patient instability. Repositioning of the valve with a single snare was ineffective because of severe aortic ring calcifications. A novel "double snare" technique was applied and the valve was successfully repositioned upward with an excellent anatomic and haemodynamic result. Conclusion: "Double snare" technique can be an effective strategy for repositioning of deeply implanted self-expanding transcatheter aortic valves. It represents an efficient bailout strategy in case of single snare approach failure, especially in cases of severe aortic ring calcifications.

Background Failure of a small surgical aortic bioprosthesis represents a challenging clinical scenario with valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) often resulting in patient-prosthesis mismatch. Bioprosthetic valve fracture (BVF) performed as a part of the ViV TAVI has recently emerged as an alternative approach with certain types of surgical bioprostheses. Case summary An 81-year-old woman with a history of three surgical aortic valve procedures presented with heart failure. Aortic bioprosthesis degeneration with severe stenosis and moderate regurgitation was found. The patient was deemed a high-risk surgical candidate and the heart team decided that ViV TAVI was the preferred treatment option. Due to the very small 19 mm stented surgical aortic bioprosthesis Mitroflow 19 mm (Sorin Group, Italy) we decided to perform BVF as a part of ViV TAVI to prevent patient-prosthesis mismatch. Since this was the first BVF procedure in our centre, an ex vivo BVF of the same kind of bioprosthetic valve was performed first. Subsequently, successful BVF with implantation of Evolut R 23 mm (Medtronic, USA) self-expandable transcatheter valve was performed. Excellent haemodynamic result was achieved and no periprocedural complications were present. The patient had an immediate major improvement in clinical status and remains asymptomatic after 6 months. Discussion Bioprosthetic valve fracture together with ViV TAVI is a safe and effective emerging technique for treatment of small surgical aortic bioprosthesis failure. Bioprosthetic valve fracture allows marked oversizing of implanted self-expandable transcatheter aortic valves, leading to excellent haemodynamic and clinical results. An ex vivo BVF can serve as an important preparatory step when introducing the new method.