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Rotational atherectomy of left main stem immediately after transcatheter aortic valve implantation in a patient with symptomatic severe aortic stenosis and an impaired left ventricular systolic function: a case report

Lookup NU author(s): Dr Mohaned Egred, Dr Mohammad Alkhalil

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

Abstract

© 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.

Publication metadata

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

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