Binder, Ronald K.

Lachat, Mario

Maisano, Francesco

English

RERO DOC Digital Library

CARDIOVASCULAR FLASHLIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .doi:10.1093/eurheartj/ehv211Online publish-ahead-of-print 3 June 2015First report of simultaneous transcatheter aortic valve replacement,endovascular aortic aneurysm repair, and permanent pacemakerimplantation after multi-vessel coronary stenting and left atrial appendageocclusionRonald K. Binder1*, Francesco Maisano2, and Mario Lachat21University Heart Center, Department of Cardiology, University Hospital Zu¨rich, Ra¨mistrasse 100, Zu¨rich, CH 8091, Switzerland; and 2University Heart Center,Department of Cardiovascular Surgery, University Hospital Zu¨rich, Zu¨rich, Switzerland*Corresponding author. Tel: +41 44 255 17 64, Fax: +4144 255 44 01, Email: ronald.binder@usz.chA 67-year-old non-compliant alcoholic withchronic renal failure, who stopped taking allmedications including oral anti-coagulation acouple of months earlier, was admitted withacute inferior–posterior ST-segment elevationmyocardial infarction. From a right radialapproach, a proximal occlusion (Panel A) of thedominant circumflex artery was successfullyrevascularized (Panel B). Significant stenosis ofthe left anterior descending (LAD) artery, theramus intermedius, and a high trans-aortic valvegradient was noted during percutaneous coron-ary intervention (PCI). Echocardiography de-monstrated severe aortic valve stenosis (PanelC). Incidentally, an abdominal aortic aneurysmmeasuring 6 cm was found during computedtomography (Panel D). The situation was interdis-ciplinary discussed between the cardiologists,heart surgeons, and vascular surgeons. It wasdecided to pursue a fully percutaneous approach.During a staged PCI, the significant lesions ofthe LAD and the intermediate branch were trea-ted with drug eluting stents. At the same time,percutaneous left atrial appendage occlusion(Panel E) with an AMPLATZERTM AmuletTM de-vice (St. Jude Medical) was performed. Then sim-ultaneous transcatheter aortic valve implantation (TAVI) (F) from a transfemoral approach using a 27 mm LotusTM valve (BostonScientific) and endovascular aneurysm repair (EVAR) with a covered Y-stent-graft was performed (Panel G). Due to intra-proceduralcomplete heart block, a permanent pacemaker (PPM) was implanted (Panel H). The patient recovered well and was found completelyasymptomatic 3 months later.This is the first report of simultaneous TAVI, EVAR, and PPM implantation. It demonstrates in a single patient the evolution of minimallyinvasive cardiovascular medicine culminating in a fully percutaneous repair of multiple coronary vessels, the aortic valve, and the aorticaneurysm while tackling bradyarrhythmias and excluding the need for oral anti-coagulation by left atrial appendage occlusion.Conflict of interest: R.K.B. serves as proctor for Boston Scientific and consultant to Edwards Lifesciences. F.M. is consultant forAbbott Vascular, ValtechCardio, Medtronic, Edwards Lifesciences and St Jude.Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: journals.permissions@oup.com.Cardiovascular flashlight 2543

First report of simultaneous transcatheter aortic valve replacement, endovascular aortic aneurysm repair, and permanent pacemaker implantation after multi-vessel coronary stenting and left atrial appendage occlusion

http://doc.rero.ch/record/291003/files/ehv211.pdf

First report of simultaneous transcatheter aortic valve replacement, endovascular aortic aneurysm repair, and permanent pacemaker implantation after multi-vessel coronary stenting and left atrial appendage occlusion

Abstract

Similar works

Full text

Available Versions

RERO DOC Digital Library