Mechanical circulatory support in patients with severe aortic stenosis and left ventricular dysfunction undergoing percutaneous coronary intervention

Abstract

Management of obstructive coronary artery disease in patients with aortic stenosis and severe left ventricular dysfunction is challenging. Mechanical circulatory support at the time of percutaneous coronary interventions may be necessary in these extreme-risk patients. We present a case in which the TandemHeart was used to support a patient with severe aortic stenosis, severe protected left main and circumflex disease, and severe cardiomyopathy and review the literature on this subject.

Management of coronary obstruction following transcatheter aortic valve replacement

“…In our case, the patient was cannulated for peripheral VA ECMO. Mechanical circulatory support has also been useful in high‐risk patients undergoing TAVR and concomitant coronary artery stenting …”

Endovascular management of an aortic rupture following transcatheter aortic valve replacement

“…Although the risk of aortic dissection is small following TAVR, it may not be immediately recognized and the mortality is high . Unlike mechanical complications such as coronary artery obstruction or the presence of severe aortic stenosis, mechanical support will not result in hemodynamic stability . The use of a high‐profile delivery system during TAVR, such as the one used in this case, may lead to an aortic rupture in an acutely angled aortic arch, as was the case in our patient …”

Trans-carotid access for TAVR allows safe and rapid exchange for bailout valve-in-valve procedures

“…In this case, the left carotid artery was free from atherosclerotic disease, while the right subclavian artery was used as a potential cannulation site for the standby ECMO. Mechanical circulatory support has been shown to be effective in patients with decreased ventricular function undergoing complicated TAVR procedures . The CoreValve was chosen because it has a high profile that guarantees the fixation to the annulus and ascending aorta when calcifications are absent.…”