Key result
Sheathless iVAC-2L provides hemodynamic support to enable combined high-risk PCI and TAVI.
Why the study?
Integrating coronary revascularization and TAVI is challenging in severe aortic stenosis, complex CAD, and severe LV dysfunction, especially when extensive PAD limits large-bore access and valve interaction must be avoided.
Case Report (n=1)
No
The novel sheathless iVAC-2L system enables fully percutaneous, integrated PCI and TAVI in patients with severe LV dysfunction and prohibitive aorto-iliac disease by providing supra-aortic pulsatile support via subclavian access.
Answers are grounded in this paper and cite their sources.
Supports feasibility of integrated PCI-TAVI with subclavian pulsatile support in prohibitive anatomy; hypothesis-generating pending prospective trials.
Background The combination of severe aortic stenosis, complex multivessel coronary artery disease and severe left ventricular systolic dysfunction represents a procedural challenge in which coronary revascularization and transcatheter aortic valve implantation (TAVI) must be carefully integrated. Mechanical circulatory support (MCS) indication and selection are crucial when extensive peripheral arterial disease limits conventional large-bore access and when interaction with valve deployment must be avoided. Case Summary An 84-year-old man was admitted to our intensive cardiac care unit (ICCU) with acute decompensated heart failure. Echocardiography showed severely reduced left ventricular ejection fraction (15%) and severe aortic stenosis (mean gradient 41 mmHg; aortic valve area by velocity-time integral 0.45 cm2). Coronary angiography revealed critical stenoses of the left main (LM), proximal and mid left anterior descending artery (LAD), and ostial and proximal right coronary artery (RCA). Computed tomography revealed extensive aorto-iliac thrombosis, narrow sinotubular junction and short valve-to-coronary distances. Following Heart Team discussion, a combined strategy was adopted. After percutaneous transluminal angioplasty of right iliac artery from right femoral access, sheathless pulsatile MCS (iVAC-2L) was implanted percutaneously via left subclavian access and positioned above the aortic leaflets. Protected percutaneous coronary intervention (PCI) of LM–LAD was then performed. TAVI with a balloon-expandable valve followed and RCA PCI was subsequently completed. MCS was maintained throughout all phases. Conclusion The new sheathless pulsatile MCS provides hemodynamic stabilization, reduces access profile compared with the previous generation of the device and enables integration of complex PCI and transfemoral TAVI in patients with hostile vascular anatomy.
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Elia et al. (2026) conducted a case report in Severe aortic stenosis, complex multivessel coronary artery disease, severe left ventricular systolic dysfunction, and extensive aorto-iliac thrombosis (n=1). Sheathless supra-aortic pulsatile mechanical support (iVAC-2L) was evaluated. The sheathless iVAC-2L system provided hemodynamic stabilization and enabled successful integration of complex PCI and transfemoral TAVI in a patient with hostile vascular anatomy.
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