10-year results of simultaneous combined procedures of coronary artery stenting and transcatheter aortic valve implantation: a clinical case

Abstract

Introduction. In recent years, transcatheter aortic valve implantation (TAVI) has become routine clinical practice in treatment of severe aortic stenosis in patients with high surgical risk. Timing of endovascular procedures is a key issue in management of patients with severe aortic valve stenosis and concomitant coronary heart disease. To date, there is no consensus on the advisability and necessity of performing simultaneous procedures of TAVI and coronary artery stenting. The long-term (over 10 years) outcomes of combined percutaneous coronary interventions in patients with severe aortic stenosis and coronary heart disease are not fully studied. Results and Methods. We described a long-term outcome in a 75-year-old female patient with marked aortic stenosis (maximum gradient = 103 mm Hg, mean gradient = 62 mm Hg, AVA area = 0.37 cm2), NYHA class II and hemodynamically significant coronary lesions. Given the high surgical risk (logistic EuroScore = 27.72%, STS = 17.21%), the patient underwent the following simultaneous procedures upon vital indications: coronary artery stenting and transcatheter aortic valve implantation with 23-mm Edwards Sapien XT prosthesis. There were no major intra- and perioperative complications. At the control examination 7 months later, the patient had no complaints. She reported an improvement in general well-being and increased tolerance of physical activities. The transprosthetic aortic blood flow parameters were as follows: peak gradient = 13 mm Hg; mean gradient = 7 mm Hg; V max = 1.8 m/s; there were 2 paraprosthetic fistulas with Grade 1–2 regurgitation. A control angiogram showed no restenosis in the coronary artery stents. 10 years after simultaneous interventions, hemodynamic parameters of the functioning aortic valve prosthesis were within the normal ranges. Control coronary angiography revealed satisfactory outcomes of coronary artery stenting. Conclusions. Simultaneous procedure of transcatheter aortic valve implantation combined with coronary artery stenting is feasible, effective, and safe. This technique can be used to treat patients with extremely high risk for open heart surgery. Keywords: aortic stenosis, transcatheter aortic valve implantation, coronary heart disease, coronary arteries, single-stage endovascular procedures