Protected complex percutaneous coronary intervention and transcatheter aortic valve replacement using extracorporeal membrane oxygenation in a high-risk frail patient: a case report

Autor:	Marcus Fischer, Christof Schmid, Kurt Debl, Lukasz Kmiec, Andreas Holzamer, M. Zerdzitzki, Michael Hilker, Lars S. Maier, Samuel Sossalla
Jazyk:	angličtina
Rok vydání:	2020
Předmět:	medicine.medical_specialty Percutaneous TAVR PCI ECMO vascular closure device case report medicine.medical_treatment Frail Elderly 610 Medizin lcsh:Medicine 030204 cardiovascular system & hematology TAVR Ventricular Function Left Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Extracorporeal Membrane Oxygenation Percutaneous Coronary Intervention Valve replacement Internal medicine medicine.artery medicine Extracorporeal membrane oxygenation Humans case report Vascular closure device Aged Aged 80 and over ddc:610 business.industry lcsh:R Percutaneous coronary intervention Stroke Volume PCI General Medicine vascular closure device medicine.disease Stenosis medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Aortic Valve Heart Valve Prosthesis Pulmonary artery Cardiology Female ECMO business Artery
Zdroj:	Journal of Medical Case Reports, Vol 14, Iss 1, Pp 1-5 (2020) Journal of Medical Case Reports
ISSN:	1752-1947
DOI:	10.1186/s13256-020-02474-x
Popis:	Background Transcatheter aortic valve replacement has become a routine procedure for patients with severe symptomatic aortic stenosis at increased surgical risk. Not much is known about using prophylactic support with venoarterial extracorporeal membrane oxygenation in patients undergoing transcatheter aortic valve replacement and eventually concomitant complex percutaneous coronary intervention. Case presentation We present a successful procedure of transcatheter aortic valve replacement and high-risk percutaneous coronary intervention utilizing venoarterial extracorporeal membrane oxygenation for hemodynamic support in a very frail 88-year-old Caucasian woman with severe symptomatic aortic stenosis and coronary bypass grafting in the past. Echocardiography revealed a “low-flow low-gradient” aortic stenosis (mean transvalvular gradient 30 mmHg, aortic valve area 0.4 cm2, significant calcification), a left ventricular ejection fraction of 35%, severe mitral regurgitation with moderate stenosis (mean transvalvular gradient 7 mmHg), with a systolic pulmonary artery pressure of 80 mmHg. Moreover, pre-interventional coronary angiography exposed a severe left main ostial stenosis and sequential subtotal heavily calcified stenosis of the left anterior descending artery . Computed tomographic angiography showed no heavy tortuosity but moderate calcification of the iliofemoral arteries. The procedure was performed under general anesthesia in our hybrid operating room. Extracorporeal membrane oxygenation was established by left femoral percutaneous cannulation using a 21-Fr venous and 15-Fr arterial cannula. Subsequently, complex percutaneous coronary intervention with implantation of two drug-eluting stents from the left main into the left anterior descending artery was performed via a right femoral arterial 7F sheath. Thereafter, a 23-mm Sapien 3 aortic valve prosthesis (Edwards, Irvine, CA, USA) was implanted via right femoral artery in the usual manner, whereby the arterial pigtail catheter for marking the aortic annulus during transcatheter aortic valve replacement was inserted over a Check-Flo® Hemostasis Assembly (Cook Medical, Bloomington, IN, USA) on a Y-adapter via the arterial extracorporeal membrane oxygenation cannula. After extracorporeal membrane oxygenation decannulation, vascular closure was easily performed using the MANTA vascular closure device in order to reduce procedural time and risk of access site complications. Conclusions In summary, we demonstrate the feasibility of elective prophylactic extracorporeal membrane oxygenation implementation in selected very high-risk and frail patients undergoing transcatheter aortic valve replacement and percutaneous coronary intervention in order to avoid intraprocedural complications.
Databáze:	OpenAIRE
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