Management of Significant Coronary Stenosis Discovered in Pre-TAVI Coronary Angiography in An 83-Year-Old Patient: When and How to Revascularize? Literature Review from a Case Report

Abstract

In recent years, we have witnessed the emergence of minimally invasive techniques such as Transcatheter Aortic Valve Implantation (TAVI) for the management of aortic valve stenosis in the elderly or at high surgical risk. TAVI, although with a low mortality rate and a simpler procedural technique, is not free from complications, especially with associated coronary artery disease. Here we report a clinical case of an 83-year-old diabetic patient with atrial fibrillation under rivaroxaban, admitted to the Angoulême hospital center for left heart failure. After management of the left heart decompensation, a transthoracic echocardiography confirms a severe aortic valve stenosis for an aortic valve surface of 0.8 cm2 and a mean trans-aortic gradient of 46 mmHG with an LVEF of 40%. A pre-therapeutic coronarography shows a tri-truncal lesion including a significant stenosis of the proximal left anterior descending artery. In view of the age of this patient, and surgical risk, a TAVI was proposed while discussing the modalities and timing of coronary revascularization.