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Lookup NU author(s): Dr Mohaned Egred, Dr Mohammad Alkhalil
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).
© 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.Background: Severe aortic stenosis (AS) and coronary artery disease (CAD) often coexist since they both share the same risk factors and pathophysiology. Patients with severe AS with prohibitive surgical risk are often treated with transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) as a staged or concurrent procedure. Significant calcified CAD and left ventricular (LV) systolic impairment in such patients would add more challenges to the management. A clear consensus on the timing of revascularization of such patients in relation to the TAVI procedure is lacking. Case summary: Herein, we present an 86-year-old male who presented to a local district hospital with non-ST-segment elevation myocardial infarction (N-STEMI) and decompensated heart failure. His transthoracic echocardiography showed moderate LV systolic impairment with low-flow severe AS. He was initially treated with dual anti-platelet and diuretic therapy and subsequently underwent coronary angiography that revealed severe calcified shelf-like left main stem (LMS) and moderate left anterior descending (LAD) disease. He was successfully treated with TAVI and rotational atherectomy (RA)-assisted PCI to LMS and LAD in the same setting. Conclusion: There is limited evidence on effective strategies to tackle high-risk angioplasty with concurrent TAVI in patients with impaired LV function. We performed TAVI and RA to LMS and LAD in the same setting using no mechanical circulatory support (MCS). Management strategies should be individualized to highly selected patients taking into account LMS involvement, calcium modulation strategies, haemodynamic instability, or cardiogenic shock and whether MCS is needed.
Author(s): Satti Z, Farag M, Egred M, Alkhalil M
Publication type: Article
Publication status: Published
Journal: European Heart Journal - Case Reports
Year: 2023
Volume: 7
Issue: 7
Print publication date: 01/07/2023
Online publication date: 08/07/2023
Acceptance date: 06/07/2023
Date deposited: 13/09/2023
ISSN (electronic): 2514-2119
Publisher: Oxford University Press
URL: https://doi.org/10.1093/ehjcr/ytad301
DOI: 10.1093/ehjcr/ytad301
Data Access Statement: The authors confirm that the data supporting the findings of this case report are available within the manuscript and its supplementary materials. Further details can be requested by contacting the corresponding author (M.A.).
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