Balloon Aortic Valvuloplasty Followed by Impella®-Assisted Left Main Coronary Artery Percutaneous Coronary Intervention in Patients With Severe Aortic Stenosis as a Bridge to Transcatheter Aortic Valve Replacement

• Published in: Cardiovascular revascularization medicine 2021-01, Vol.22, p.16-21
• Main Authors: Diaz Quintero, Luis, Gajo, Eileen, Guerrero, Mayra, Feldman, Ted, Levisay, Justin
• Format: Article
• Language: English
• Subjects: Balloon aortic valvuloplasty; Impella; Left main coronary artery PCI; Transcatheter aortic valve replacement
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2020.06.003

The use of Impella® to provide hemodynamic support during unprotected left main coronary artery (LMCA) percutaneous coronary intervention (PCI) has been shown to be feasible, but severe AS is a relative contraindication for its use. Balloon aortic valvuloplasty (BAV) may facilitate the use of Impella® in these patients. To assess the feasibility of BAV followed by Impella®-assisted LMCA PCI in patients with severe AS as bridge to TAVR. Patients with symptomatic severe AS with LMCA stenosis ≥70% requiring PCI prior to TAVR were included. Outcomes were retrospectively collected. Seven patients underwent BAV followed by Impella®-assisted LMCA PCI. Five patients were male; mean age 86 (75–91; SD ± 5.5). Mean STS score was 6.5% (4.3–13.8; SD ± 3.4). Impella® 2.5 L was used in all cases. The procedure was successful in all patients without peri-procedure complications. At 30-day post-BAV/PCI follow up, all patients had experienced improvement in NYHA class (N = 2 NYHA IV to III, N = 5 NYHA III to II). At such interval, mean EF was 54% (30–77; SD ± 17.7). The post BAV change in AVA [0.8 cm2 (0.4–1.5; SD ± 0.3; P = 0.07)], and AV mean gradient [30.8 mmHg (21–45; SD ± 8.9; P = 0.95)] after the procedure were not statistically significant. All patients underwent TAVR after a median PCI-to-TAVR interval of 62 days (33–339; SD ± 96.7). BAV followed by Impella®-assisted LMCA PCI appears to be a feasible strategy for intermediate and high surgical risk patients with severe AS undergoing LMCA PCI as bridge to TAVR. •Coronary artery intervention in aortic stenosis could cause hemodynamic instability.•Severe aortic stenosis is a relative contraindication for Impella use.•Impella®-assisted left main coronary intervention may be feasible.