Video : Simultaneous Complex Coronary PCI and TAVI Procedures

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Cardiology / Coronary / Pci / Case in the box

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CASE 01: Simultaneous Complex LAD PCI & TAVI in bicuspid Aortic stenosis-Dr.Georg NICKENIG

This TAVI procedure concerns a 60 years old male , with medical history of Diabetes mellitus, Atrial fibrillation,Chronic Kidney disease and severe paripheral artery disease,

Presenting syncope and short cardiac arrest complicating severe bicuspid aortic stenosis and svere coronary artery disease ,

Strategy Plan

Imaging studies

Echo: LVEF:39%, Vmax:4m/s , AVA:0.7cm², annulus: 26mm, MR1
Coronary angiography: Three vessels disease: Distal LMCA:50% , Ostial LAD:90% , Mid LAD: 80% long, LCx ostial :50%.
Cardiac CT: Aortic annulus:34.2x24.3mm, Perimeter:93.7mm

Clinical indication

Severe bicuspid aortic stenosis with comorbidities( Log EUROSCORE:8.42% , STS Score:4%).
Heart Team decision : Turned down for open heart surgery.

Planned Procedure

LAD PCI
Transfemoral TAVI with Edwards Sapien 3

CASE 02: Complex PCI of the Left main & LAD-D1 bifurcation-Dr.Eberhard GRUBE

This coronary procedure concerns a 78 years old female , with medical history of CABG, HIV infection, HBP.

Presenting severe stable angina and severe native coronary artery disease with functional occluded LIMA-LAD as well as SVG-DI-OM1.

Strategy Plan

Imaging studies

Coronary angiography: Three vessels disease: calcified distal LM stenosis,ostial and proximal LAD-D1 bifurcation stenosis, Functional occluded LIMA-LAD,Ostial RCx stenosis,Jump SVG-OM1-D1 occluded ,SVG-RCA : 80% stenosis, Patent native RCA.
Echo: Preserved LV EF 60%

Clinical indication

Heart failure II-III NYHA , angina II CCS Log EUROSCORE :28.38%
Heart Team decision

Planned Procedure

PCI of the distal Left main and Proximal LAD-D1 bifurcation

CASE 03: Complex Left main PCI -Dr.Nikos WERNER

This coronary PCI procedure concerns a 86 years old female , with HBP and dyslipidemia, she underwent LAD PCI in the past.

Presenting heart failure and severe coronary artery lesions treated in the same session using Lithoplasty with shockwave.

Strategy Plan

Imaging studies

Coronary angiography: Two vessels disease: Proximal Left main 70%, Mid-LAD 70%
Echo: Preserved LV EF 65%

Clinical indication

Heart failure III NYHA , Log EUROSCORE :5.1%
Heart Team decision

Planned Procedure

PCI with coronary lithoplasty with Shockwave

Shooting date : 2018-02-22
Last update : 2021-06-09