title: Simultaneous rota-stenting and transcatheter aortic valve implantation for patients with heavily calcified coronary stenosis and aortic stenosis.
abstract: Given that coronary artery disease (CAD) in octogenarians undergoing transcatheter aortic valve implantation (TAVI) often presents with more complex lesions and extensive calcification, rotational atherectomy (RA) may be needed in some cases before stenting. However, data regarding the feasibility and safety of simultaneous RA during TAVI using the Medtronic CoreValve (MCV; Medtronic, Minneapolis, MN, USA) system are lacking. Three out of 107 (2.8%) patients (2 females, average age 85.6 years, mean aortic valve area 0.5 cm(2), mean left ventricular ejection fraction 39%, mean Logistic EuroScore 70%), with complex, heavily calcified coronary stenosis, and severe valvular aortic stenosis (AS) were treated with TAVI and RA due to high surgical risk. After balloon valvuloplasty, all coronary lesions were successfully treated with RA and stenting, immediately followed by transfemoral TAVI with a self-expandable MCV. Our data suggested that in the very elderly patients with severe and heavily calcified CAD and AS who were turned down for cardiac surgery, RA and stenting followed by TAVI may be performed successfully in a combined, single-stage procedure.
authors.affiliation: Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC.
authors.forename: Yung-Tsai
authors.initials: YT
authors.lastname: Lee
authors.affiliation: Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: yinwh@pchome.com.tw.
authors.forename: Wei-Hsian
authors.initials: WH
authors.lastname: Yin
authors.affiliation: Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC.
authors.forename: Ho-Ping
authors.initials: HP
authors.lastname: Yu
authors.affiliation: Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC.
authors.forename: Jeng
authors.initials: J
authors.lastname: Wei
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D023921:Coronary Stenosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D015607:Stents; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D061205:Vascular Calcification / Q000601:surgery*
keywords: coronary artery disease; percutaneous coronary intervention; rotational atherectomy; transcatheter aortic valve implantation; valvular aortic stenosis