Key result
Simultaneous Impella-assisted PCI and TAVR achieves 100% procedural success without death or stroke despite frequent pacemakers.
Why the study?
Percutaneous management of high-risk PCI requiring mechanical support in patients needing TAVR for severe aortic stenosis remains incompletely defined.
Cohort (n=12)
Yes
A single-session strategy of Impella-assisted complex high-risk PCI followed by TAVR appears feasible and safe in highly selected patients with complex CAD and severe AS.
Answers are grounded in this paper and cite their sources.
Suggests single-session Impella-assisted PCI and TAVR may be feasible in selected patients; hypothesis-generating and requires randomized confirmation.
Background Percutaneous management of high risk, percutaneous coronary intervention (PCI) needing mechanical support for complex coronary artery disease in patients needing transcatheter aortic valve replacement for severe aortic stenosis remains incompletely defined. We report on the feasibility and safety of a single-session strategy using Impella-assisted complex high-risk PCI (IA-CHIP) followed by transcatheter aortic valve replacement (TAVR). Methods We conducted a multicenter retrospective study of consecutive patients undergoing simultaneous IA-CHIP and TAVR at 3 tertiary centers between January 2015 and March 2026. All patients received mechanical circulatory support with percutaneous microaxial flow pump Impella CP (Abiomed) during PCI, followed by transfemoral TAVR in the same session. Baseline demographics, procedural characteristics, and clinical outcomes were collected. The primary endpoint was in-hospital complications, including death, stroke, major bleeding (Bleeding Academic Research Consortium types 2, 3, or 5), acute kidney injury, permanent pacemaker implantation, and vascular complications. Results A total of 12 patients were included (median age, 79.5 years [IQR, 77.0-81.2]; 91.7% male; median Charlson Comorbidity Index of 7 [IQR, 5.8-9]). Coronary lesions mainly involved left main disease in 66% of cases. Advanced calcium modification was required in 50% of cases. The median aortic valve area was 0.86 cm 2 , and median mean gradient was 38 mm Hg. Procedural success for IA-CHIP and TAVR was 100%. There were no in-hospital deaths, strokes, or major vascular complications. Conduction disturbances requiring permanent pacemaker implantation occurred in 25%. An acute kidney injury occurred in 16.7% of cases, with no requirement for dialysis. The majority of patients (91.7%) were discharged home. Conclusions A single-session strategy of IA-CHIP followed by TAVR is feasible and safe in selected patients with complex coronary artery disease and severe aortic stenosis.
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Rivera et al. (2026) conducted a cohort in Complex coronary artery disease and severe aortic stenosis (n=12). Simultaneous Impella-assisted complex high-risk PCI (IA-CHIP) and TAVR was evaluated on In-hospital complications, including death, stroke, major bleeding, acute kidney injury, permanent pacemaker implantation, and vascular complications. Simultaneous Impella-assisted complex high-risk PCI and TAVR achieved 100% procedural success with no in-hospital deaths or strokes, though 25% required permanent pacemaker implantation.
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