Key result
VA-ECMO plus RVAD successfully rescues acute RCA occlusion and cardiogenic shock during TAVR.
Why the study?
Acute coronary obstruction is a rare but serious complication of TAVR, with right coronary ostial occlusion being less common and less well characterized than left coronary obstruction.
Case Report (n=1)
Answers are grounded in this paper and cite their sources.
Acute coronary obstruction is a relatively rare complication of transcatheter aortic valve replacement (TAVR). Left coronary ostial obstruction is much more common compared to right coronary occlusion due to its relatively lower ostial height from the aortic annulus. We present a case of acute ostial right coronary occlusion immediately upon deployment of a 29-mm Sapien 3 transcatheter aortic valve. The acute right coronary ostial occlusion manifested with ventricular fibrillation, acute right ventricular failure, and right-sided cardiogenic shock. The patient, after undergoing an initial unsuccessful attempt at percutaneous revascularization, was placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This was later transitioned to percutaneous right atrial to pulmonary artery right ventricular support, which led to subsequent recovery.
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Joshi et al. (2020) conducted a case report in Severe aortic stenosis complicated by acute right coronary artery occlusion (n=1). Veno-arterial ECMO and percutaneous right ventricular assist device (RVAD) was evaluated. Acute right coronary artery occlusion and cardiogenic shock during transcatheter aortic valve replacement was successfully managed with veno-arterial ECMO and a right ventricular assist device.
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