title: Mechanical circulatory support with impella to facilitate percutaneous coronary intervention for post-TAVI bilateral coronary obstruction.
abstract: One of the potential complications of transcatheter aortic valve implantation (TAVI) is coronary obstruction (CO), which can occur by displacement of heavily calcified native valve cusps against the coronary ostium. Treatment mandates immediate percutaneous coronary intervention (PCI) to restore coronary flow and improve hemodynamics and if unsuccessful, urgent implementation of circulatory support, commonly extracorporeal, with subsequent surgical revascularization. We report a case of post-TAVI CO for which successful emergent deployment of Impella percutaneous mechanical circulatory support to restore hemodynamic stability facilitated definitive treatment with bilateral PCI. Impella support represents an expeditious, effective, and widely available therapy to complement and facilitate PCI in the treatment of CO complicating TAVI, and may diminish requirement for urgent coronary artery bypass surgery. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiology, Henry Ford Health System, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Tiberio M
authors.initials: TM
authors.lastname: Frisoli
authors.affiliation: Division of Cardiology, Henry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan.
authors.forename: Mayra
authors.initials: M
authors.lastname: Guerrero
authors.affiliation: Division of Cardiology, Henry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan.
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000628:therapy*; D001027:Aortography; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D017023:Coronary Angiography; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D062645:Percutaneous Coronary Intervention; D011474:Prosthesis Design; D020127:Recovery of Function; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: aortic valve stenosis; cardiogenic shock; coronary intervention