Rotational atherectomy through a coronary artery bypass graft after transcatheter aortic valve implantation: a case report

European Heart Journal. Case Reports
Edgar IllescasPierre Deharo

Abstract

Aortic stenosis (AS) in the elderly is frequently associated with complex coronary artery disease. Rotational atherectomy (RA) in this clinical setting is challenging because coronary slow flow could lead to haemodynamic instability aggravated by the severe AS. We present the case of an 83-year-old woman with symptomatic severe AS, mildly decreased left ventricular ejection fraction and history of coronary artery bypass grafting with right internal mammary artery (RIMA) to the right coronary artery (RCA) and left internal mammary artery to the left anterior descending artery and further percutaneous coronary intervention (PCI) to the circumflex. First, we performed a transcatheter aortic valve implantation (TAVI) to treat the severe AS. Because of persistent symptoms despite good result, we then performed RA of the native RCA through the RIMA with a Guidezilla® guide extension catheter. A two-staged procedure of TAVI and PCI with RA of the RCA via RIMA was successfully performed. We decided to perform the PCI after the TAVI to allow a better haemodynamic tolerance of the complex coronary intervention. This procedure needs caution as the conduit is fragile and could be easily damaged during the RA. No data are available about fe...Continue Reading

References

Dec 30, 2014·Cardiovascular Revascularization Medicine : Including Molecular Interventions·Anna PiccoliFlavio Ribichini
Jul 15, 2015·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Lachlan T CouperUNKNOWN Melbourne Interventional Group (MIG) Investigators
Sep 10, 2017·European Heart Journal·Helmut BaumgartnerUNKNOWN ESC Scientific Document Group
Oct 19, 2017·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Michael S LeeRichard Shlofmitz

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Citations

Jul 16, 2021·Cardiovascular Revascularization Medicine : Including Molecular Interventions·Nirat BeoharBrad J Martinsen

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Methods Mentioned

BETA
coronary artery bypass
sedation

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