title: Staged High-Risk Percutaneous Coronary Intervention with Impella Support after On-Pump Transcatheter Aortic Valve Replacement.
abstract: The management of concomitant obstructive coronary artery disease and severe aortic stenosis in poor surgical candidates is an evolving topic. Although the typical current practice is to perform percutaneous revascularization before transcatheter aortic valve replacement (TAVR), some data have emerged regarding revascularization after performing TAVR. We present the case of a 90-year-old man with multivessel coronary artery disease who was at prohibitive risk for surgical aortic valve replacement. We first performed TAVR with use of hemodynamic support, then Impella-assisted multivessel percutaneous coronary intervention on the patient's unprotected left main coronary artery. We describe this complex case and review the medical literature on percutaneous coronary intervention after TAVR.
authors: Sameer
authors: S
authors: Arora
authors: Amol A
authors: AA
authors: Bahekar
mesh_terms: D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000295:instrumentation; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D016277:Ventricular Function, Left
keywords: Aged, 80 and over; aortic valve stenosis/complications/therapy; heart valve diseases/complications; heart valve prosthesis implantation/instrumentation/methods; percutaneous coronary intervention/instrumentation/methods; risk assessment; treatment outcome