CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC_11(12)_62210.15836/ccar2016.622Extended AbstractTransapical transcatheter aortic valve implantation and percutaneous coronary intervention in a patient with porcelain aortahttp://orcid.org/0000-0001-8502-7816GulinDario1http://orcid.org/0000-0003-4488-0559ŠikićJozica1http://orcid.org/0000-0002-5707-0961GalićEdvard1http://orcid.org/0000-0001-6926-9436SutlićŽeljko2University Hospital “Sveti Duh”, Zagreb, CroatiaUniversity Hospital Dubrava, Zagreb, CroatiaAddress for correspondence: Dario Gulin, Klinička bolnica Sveti Duh, Sveti Duh 64, HR-10000 Zagreb, Croatia. / Phone: +385-91-3713-398 / E-mail: dariogulin@gmail.com112016111262262210112016201120162016Croatian Cardiac SocietyKeywords: aortic stenosiscoronary artery bypasspercutaneous coronary intervention
Introduction: In addition to standard surgical aortic valve replacement (SAVR), transcatheter implantation (TAVI) provides a safe alternative, particularly in patients with an increased risk due to the presence of other comorbidities. Other comorbidities also influence on selection of the TAVI access (1, 2).
Case report: 73-year-old male patient, with prior history of myocardial infarction and coronary artery bypass grafting (CABG) – (LIMA-LAD – left internal mammary artery to left anterior descending artery; SVG-PD, OM2 – saphenous vein graft to posterior descending artery and second left marginal artery) in 1997, was admitted to University Hospital in February 2013 due to syncope and chest pain. Echocardiography revealed severe aortic stenosis. Coronary artery angiography showed occluded venous bypass grafts and suboccluded circumflex artery (CX) and left internal mammary artery graft (LIMA). Other coronary arteries were completely atherosclerotically changed and inappropriate for percutaneous coronary intervention (PCI). Significant carotid artery disease has been shown. The patient was prepared for synchronous carotid thromboendarterectomy, surgical aortic valve replacement, and re-CABG. In June 2013 carotid procedure was performed, while SAVR and re-CABG could not be done due to porcelain aorta. Due to prolonged chest pain, PCI of CX and LIMA graft was done. After PCI the patient was free of chest pain but left ventricle (LV) function decreased to moderately reduced ejection fraction. Transfemoral approach for transcatheter aortic valve implantation (TAVI) could not be used due to significant peripheral artery disease. In 2014 transapical (first Croatian) TAVI was done. In 2015 due to tachy-brady syndrome permanent pacemaker was implanted. In the follow-up period, LV function significantly improved and the patient was free of chest pain.
Conclusion: TAVI and PCI are safe alternatives to SAVR and CABG in selected high-risk patients with porcelain aorta. In inoperable patients, who are not candidates for transfemoral TAVI and concomitant significant coronary artery disease with previously performed CABG, careful selection of alternative access options, following PCI can lead to excellent results.
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