Impella-supported PCI prior to transfemoral TAVR via a femoral Y-graft was feasible and safe in a patient with LFLG AS, improving left ventricular ejection fraction from 10% to 35% at 3 months.
Case Report (n=1)
Impella-supported PCI followed by transfemoral TAVR via a femoral Y-graft is a feasible and safe strategy for high-risk patients with LFLG AS, severe CAD, and severely reduced LVEF.
Abstract Introduction Low-flow, low-gradient aortic stenosis (LFLG AS) is a subset of aortic stenosis associated with a poor prognosis and high operative risk, particularly in the presence of concomitant coronary artery disease requiring intervention. In patients considered inoperable, minimally invasive approaches often remain the only alternative. However, there are limited data on treatment strategies and outcomes in patients with LFLG AS and severe ischemic cardiomyopathy undergoing percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR), especially in cases with challenging transfemoral access. Case summary An 87-year-old male presented with progressive dyspnea and angina. Diagnostics revealed a non-ST-segment elevation myocardial infarction (NSTEMI), acute heart failure, acute-on-chronic renal failure, LFLG AS (aortic valve area of 0.7 cm²), and a left ventricular ejection fraction of 10%. Coronary angiography showed severe coronary artery disease requiring revascularization. Due to excessive surgical risk, we planned a staged interventional treatment by Heart Team consensus. First, high-risk PCI with mechanical circulatory support was performed, followed by transfemoral TAVR using a self-expandable 29-mm bioprosthesis via a femoral Y-graft conduit. The patient reported immediate relief of symptoms. Follow-up echocardiography at discharge and at three months showed improvement of the aortic valve function and an increase of the ejection fraction to 35%. The patient remained asymptomatic and resumed his daily activities. Discussion This case demonstrates that Impella®-supported PCI prior to transfemoral TAVR is feasible and safe, even in the presence of a femoral Y-graft, in a patient with LFLG AS and severely reduced ejection fraction.
Nejahsie et al. (Thu,) conducted a case report in Low-flow, low-gradient aortic stenosis and severe ischemic cardiomyopathy (n=1). Impella-supported PCI followed by transfemoral TAVR via a femoral Y-graft conduit was evaluated on Improvement of aortic valve function and ejection fraction. Impella-supported PCI prior to transfemoral TAVR via a femoral Y-graft was feasible and safe in a patient with LFLG AS, improving left ventricular ejection fraction from 10% to 35% at 3 months.