Balloon Aortic Valvuloplasty Followed by Impella®-Assisted Left Main Coronary Artery Percutaneous Coronary Intervention in Patients With Severe Aortic Stenosis as a Bridge to Transcatheter Aortic Valve Replacement |
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| Institution: | 1. Division of Cardiology, Department of Medicine, University of Colorado, Aurora, Colorado;2. Department of Medicine, VA Eastern Colorado Health Care System, Aurora, Colorado;3. Department of Biostatistics and Informatics, University of Colorado, Aurora, Colorado;4. Department of Medicine, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania;5. Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;6. Michigan Heart and Vascular Institute, Ann Arbor, Michigan;1. Wayne State University School of Medicine, Detroit Medical Center, Detroit, Michigan;2. RWJ-Barnabas Health Structural Heart Leadership Group, Newark Beth Israel Medical Center, Newark, New Jersey;3. Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia;4. Heart & Vascular Institute, Dearborn, Michigan;5. Ascension St. John Hospital, Detroit, Michigan;1. Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands;2. Mount Sinai Medical Center, New York, NY, United States;3. Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, United States;4. Beth Israel Deaconess Medical Center, Boston, Ma, United States;5. Boston University, Boston, Ma, United States;6. Morristown Medical Center, Morristown, NJ, United States;7. Duke University Medical Center, United States;8. Henry Ford Hospital, Detroid, Mi, United States;1. New Tokyo Hospital, Matsudo, Japan;2. Ogaki Municipal Hospital, Ogaki, Japan;3. Teikyo University School of Medicine, Tokyo, Japan;4. Kokura Memorial Hospital, Kokura, Japan;5. Saiseikai Yokohama-City Eastern Hospital, Tsurumi, Japan;6. Sendai Kousei Hospital, Sendai, Japan;7. Shonan Kamakura General Hospital, Kamakura, Japan;8. Toyohashi Heart Center, Toyohashi, Japan;9. Kishiwada Tokushukai Hospital, Osaka, Japan;10. Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan;11. Osaka City University Graduate School of Medicine, Osaka, Japan;12. University of Toyama, Toyama, Japan;13. Keio University School of Medicine, Tokyo, Japan |
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| Abstract: | BackgroundThe use of Impella® to provide hemodynamic support during unprotected left main coronary artery (LMCA) percutaneous coronary intervention (PCI) has been shown to be feasible, but severe AS is a relative contraindication for its use. Balloon aortic valvuloplasty (BAV) may facilitate the use of Impella® in these patients.ObjectiveTo assess the feasibility of BAV followed by Impella®-assisted LMCA PCI in patients with severe AS as bridge to TAVR.MethodsPatients with symptomatic severe AS with LMCA stenosis ≥70% requiring PCI prior to TAVR were included. Outcomes were retrospectively collected.ResultsSeven patients underwent BAV followed by Impella®-assisted LMCA PCI. Five patients were male; mean age 86 (75–91; SD ± 5.5). Mean STS score was 6.5% (4.3–13.8; SD ± 3.4). Impella® 2.5 L was used in all cases. The procedure was successful in all patients without peri-procedure complications. At 30-day post-BAV/PCI follow up, all patients had experienced improvement in NYHA class (N = 2 NYHA IV to III, N = 5 NYHA III to II). At such interval, mean EF was 54% (30–77; SD ± 17.7). The post BAV change in AVA 0.8 cm2 (0.4–1.5; SD ± 0.3; P = 0.07)], and AV mean gradient 30.8 mmHg (21–45; SD ± 8.9; P = 0.95)] after the procedure were not statistically significant. All patients underwent TAVR after a median PCI-to-TAVR interval of 62 days (33–339; SD ± 96.7).ConclusionsBAV followed by Impella®-assisted LMCA PCI appears to be a feasible strategy for intermediate and high surgical risk patients with severe AS undergoing LMCA PCI as bridge to TAVR. |
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