title: Pre-emptive positioning of a coronary stent in the left anterior descending artery for left main protection: a prerequisite for transcatheter aortic valve-in-valve implantation for failing stentless bioprostheses?
abstract: Transcatheter aortic valve-in-valve (VIV) implantation in high-risk patients with degenerative surgical bioprosthetic aortic valves is a novel application of transcatheter aortic valve replacement technology. Although transcatheter aortic VIV procedure is clinically effective in most patients, it is a more demanding procedure in terms of the technical aspects of procedural planning. VIV carries a higher risk of coronary occlusion which is associated with a higher rate of in-hospital mortality. We hereby report a technique of pre-emptive left main (LM) protection, by positioning a coronary stent in the proximal left anterior descending artery prior to VIV implantation. The patient treated was considered to be at an increased risk of LM occlusion as a result of the procedure. The technique was performed in anticipation of emergent bailout stenting of the LM. As predicted, the LM occluded during the procedure and LM protection facilitated the safe and effective treatment of an otherwise life-threatening procedure.
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kashif
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage; D054059:Coronary Occlusion / Q000209:etiology / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; D020123:Sirolimus
keywords: left main coronary disease; percutaneous coronary intervention; valvular heart disease