Key result
Emergent self-expanding TAVI plus Impella successfully restores hemodynamic stability.
Why the study?
Determining the treatment strategy for cardiogenic shock following ST-elevation myocardial infarction in a patient with severe aortic stenosis remains challenging and is a matter of debate.
Does combined transcatheter aortic valve implantation and left ventricular assist device placement improve haemodynamic stability in a patient with severe aortic stenosis and cardiogenic shock after primary PCI for STEMI?
Case Report (n=1)
No
Does combined transcatheter aortic valve implantation and left ventricular assist device placement improve haemodynamic stability in a patient with severe aortic stenosis and cardiogenic shock after primary PCI for STEMI?
Combined transcatheter aortic valve implantation and left ventricular assist device placement can be an effective strategy for managing cardiogenic shock in patients with severe aortic stenosis following primary PCI for STEMI.
Hypothesis-generating for combined TAVI and LVAD in post-STEMI cardiogenic shock with severe AS; prospective validation required before practice change.
BACKGROUND: Determining the treatment strategy for cardiogenic shock following ST-elevation myocardial infarction in a patient with severe aortic stenosis remains challenging and is a matter of debate. CASE SUMMARY: An 84-year-old man with chest pain was transferred to our institute and subsequently diagnosed with ST-elevation myocardial infarction and Killip class III heart failure. The patient was intubated, and urgent coronary angiography revealed severe tandem stenosis from the proximal to mid-left anterior descending coronary artery. We performed a primary percutaneous coronary intervention (PCI) and deployed drug-eluting stents from the left main trunk to mid-left anterior descending coronary artery. Although the procedure was successful, the patient went into cardiogenic shock a few hours later. Transthoracic echocardiography revealed low cardiac function and severe aortic stenosis. We decided to perform transcatheter aortic valve implantation using a self-expandable valve, followed by the insertion of a left ventricular assist device. The combination of procedures achieved haemodynamic stability. DISCUSSION: It is difficult to treat cardiogenic shock that develops in patients with severe aortic stenosis and ST-elevation myocardial infarction. This case report demonstrates that combined transcatheter aortic valve replacement using a self-expanding valve and left ventricular assist device placement can be safe and effective after a primary PCI.
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Konami et al. (2021) conducted a case report in Cardiogenic shock with severe aortic stenosis following ST-elevation myocardial infarction (n=1). Transcatheter aortic valve implantation (TAVI) and Impella CP device insertion was evaluated. Combined transcatheter aortic valve implantation using a self-expanding valve and left ventricular assist device placement safely and effectively achieved hemodynamic stability.
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