One-stop operation of percutaneous coronary intervention for left main bifurcation disease and transcatheter aortic valve replacement: a case report_West China Medical Journal

Authors：

 SUN Zhiqi ¹ , WANG Baiying ¹ , WANG Hao ¹ , WANG Hanmei ² , XU Jianjun ³ , SHANG Ruiping ¹ , SUO Chuantao ¹

1. Department of Cardiology, Daqing Oilfield General Hospital, Daqing, Heilongjiang 163000, P. R. China;
2. Department of Cardiac Ultrasound, Daqing Oilfield General Hospital, Daqing, Heilongjiang 163000, P. R. China;
3. Department of Anesthesiology, Daqing Oilfield General Hospital, Daqing, Heilongjiang 163000, P. R. China;

Corresponding author：

SUN Zhiqi, Email: zhiqisun6872@hotmail.com

Keywords：

Severe aortic stenosis; transcatheter aortic valve replacement; percutaneous coronary intervention

DOI：

10.7507/1002-0179.202202034

Video：

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Transcatheter aortic valve replacement (TAVR) has become one of the main treatments for severe aortic stenosis. However, percutaneous coronary intervention (PCI) is often required in elderly patients who combine with coronary artery disease. This paper reports a case of one-stop TAVR+PCI operation for a 71-year-old male patient with left main bifurcation lesions and severe aortic stenosis. During the procedure, first of all, the coronary arteries were assessed by angiography, and the pigtail catheter was implanted in the left ventricle after the straight guidewire transvalved successfully; then PCI was performed on the diseased coronary arteries; finally, the stenosis of aortic valve was treated with TAVR. After operation, the hemodynamics of the patient was stable and symptoms were significantly improved, showing a good clinical effect of one-stop operation of TAVR+PCI.

Citation： SUN Zhiqi, WANG Baiying, WANG Hao, WANG Hanmei, XU Jianjun, SHANG Ruiping, SUO Chuantao. One-stop operation of percutaneous coronary intervention for left main bifurcation disease and transcatheter aortic valve replacement: a case report. West China Medical Journal, 2022, 37(4): 501-506. doi: 10.7507/1002-0179.202202034 Copy

1.	周达新, 潘文志, 吴永健, 等. 经导管主动脉瓣置换术中国专家共识(2020 更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
2.	Barbanti M, Todaro D, Costa G, et al. Optimized screening of coronary artery disease with invasive coronary angiography and Ad Hoc percutaneous coronary intervention during transcatheter aortic valve replacement. Circ Cardiovasc Interv, 2017, 10(8): e005234.
3.	Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
4.	Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
5.	Popma JJ, Adams DH, Reardon MJ, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol, 2014, 63(19): 1972-1981.
6.	Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
7.	Thyregod HGH, Ihlemann N, Jørgensen TH, et al. Five-year clinical and echocardiographic outcomes from the Nordic Aortic Valve Intervention (NOTION) randomized clinical trial in lower surgical risk patients. Circulation, 2019, 139: 2714-2723.
8.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e72-e227.
9.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2021, 60(4): 727-800.
10.	Baron SJ, Arnold SV, Herrmann HC, et al. Impact of ejection fraction and aortic valve gradient on outcomes of transcatheter aortic valve replacement. J Am Coll Cardiol, 2016, 67(20): 2349-2358.
11.	Witberg G, Regev E, Chen S, et al. The prognostic effects of coronary disease severity and completeness of revascularization on mortality in patients undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2017, 10(14): 1428-1435.
12.	Van Rosendael PJ, Van Der Kley F, Kamperidis V, et al. Timing of staged percutaneous coronary intervention before transcatheter aortic valve implantation. Am J Cardiol, 2015, 115(12): 1726-1732.
13.	Blumenstein J, Kim WK, Liebetrau C, et al. Challenges of coronary angiography and intervention in patients previously treated by TAVI. Clin Res Cardiol, 2015, 104(8): 632-639.
14.	Bajaj A, Pancholy S, Sethi A, et al. Safety and feasibility of PCI in patients undergoing TAVR: a systematic review and meta-analysis. Heart Lung, 2017, 46(2): 92-99.
15.	Chakravarty T, Sharma R, Abramowitz Y, et al. Outcomes in patients with transcatheter aortic valve replacement and left main stenting: the TAVR-LM registry. J Am Coll Cardiol, 2016, 67(8): 951-960.
16.	Penkalla A, Pasic M, Drews T, et al. Transcatheter aortic valve implantation combined with elective coronary artery stenting: a simultaneous approach. Eur J Cardiothorac Surg, 2015, 47(6): 1083-1089.
17.	Wendt D, Kahlert P, Lenze T, et al. Management of high-risk patients with aortic stenosis and coronary artery disease. Ann Thorac Surg, 2013, 95(2): 599-605.
18.	Søndergaard L, Popma JJ, Reardon MJ, et al. Comparison of a complete percutaneous versus surgical approach to aortic valve replacement and revascularization in patients at intermediate surgical risk: results from the randomized SURTAVI trial. Circulation, 2019, 140: 1296-1305.
19.	Sabbah M, Engstrøm T, De Backer O, et al. Coronary assessment and revascularization before transcutaneous aortic valve implantation: an update on current knowledge. Front Cardiovasc Med, 2021, 8: 654892.

1. 周达新, 潘文志, 吴永健, 等. 经导管主动脉瓣置换术中国专家共识(2020 更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
2. Barbanti M, Todaro D, Costa G, et al. Optimized screening of coronary artery disease with invasive coronary angiography and Ad Hoc percutaneous coronary intervention during transcatheter aortic valve replacement. Circ Cardiovasc Interv, 2017, 10(8): e005234.
3. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
4. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
5. Popma JJ, Adams DH, Reardon MJ, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol, 2014, 63(19): 1972-1981.
6. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
7. Thyregod HGH, Ihlemann N, Jørgensen TH, et al. Five-year clinical and echocardiographic outcomes from the Nordic Aortic Valve Intervention (NOTION) randomized clinical trial in lower surgical risk patients. Circulation, 2019, 139: 2714-2723.
8. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e72-e227.
9. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2021, 60(4): 727-800.
10. Baron SJ, Arnold SV, Herrmann HC, et al. Impact of ejection fraction and aortic valve gradient on outcomes of transcatheter aortic valve replacement. J Am Coll Cardiol, 2016, 67(20): 2349-2358.
11. Witberg G, Regev E, Chen S, et al. The prognostic effects of coronary disease severity and completeness of revascularization on mortality in patients undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2017, 10(14): 1428-1435.
12. Van Rosendael PJ, Van Der Kley F, Kamperidis V, et al. Timing of staged percutaneous coronary intervention before transcatheter aortic valve implantation. Am J Cardiol, 2015, 115(12): 1726-1732.
13. Blumenstein J, Kim WK, Liebetrau C, et al. Challenges of coronary angiography and intervention in patients previously treated by TAVI. Clin Res Cardiol, 2015, 104(8): 632-639.
14. Bajaj A, Pancholy S, Sethi A, et al. Safety and feasibility of PCI in patients undergoing TAVR: a systematic review and meta-analysis. Heart Lung, 2017, 46(2): 92-99.
15. Chakravarty T, Sharma R, Abramowitz Y, et al. Outcomes in patients with transcatheter aortic valve replacement and left main stenting: the TAVR-LM registry. J Am Coll Cardiol, 2016, 67(8): 951-960.
16. Penkalla A, Pasic M, Drews T, et al. Transcatheter aortic valve implantation combined with elective coronary artery stenting: a simultaneous approach. Eur J Cardiothorac Surg, 2015, 47(6): 1083-1089.
17. Wendt D, Kahlert P, Lenze T, et al. Management of high-risk patients with aortic stenosis and coronary artery disease. Ann Thorac Surg, 2013, 95(2): 599-605.
18. Søndergaard L, Popma JJ, Reardon MJ, et al. Comparison of a complete percutaneous versus surgical approach to aortic valve replacement and revascularization in patients at intermediate surgical risk: results from the randomized SURTAVI trial. Circulation, 2019, 140: 1296-1305.
19. Sabbah M, Engstrøm T, De Backer O, et al. Coronary assessment and revascularization before transcutaneous aortic valve implantation: an update on current knowledge. Front Cardiovasc Med, 2021, 8: 654892.

West China Medical Journal

One-stop operation of percutaneous coronary intervention for left main bifurcation disease and transcatheter aortic valve replacement: a case report

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