Endovascular myocardial revascularization in a patient after transcatheter aortic valve implantation: a case report

Transcatheter aortic valve implantation (TAVI) is an effective and safe method for treating aortic stenosis (AS), especially in patients at high surgical risk. With the improvement of the quality and increase in life expectancy of the population, comorbid patients with critical AS will increasingly be encountered in practice, for whom TAVI will be the main method of surgical treatment. Despite the achieved successes in the management of patients with cardiovascular diseases, their cotinuous progression can lead to de novo atherosclerotic lesions or restenosis in the previously stented coronary segment. The design of prosthetic aortic valves used in TAVI can impose a number of technical limitations when repeated coronary interventions are necessary. This article presents a case of successful endovascular treatment of multivessel coronary artery disease guided by intravascular coronary flow assessment in a comorbid patient after TAVI.

1. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022; 43(7):561-632. doi:10.1093/eurheartj/ehab395.

2. Modine T, Tchétché D, Van Mieghem N, et al. Three-Year Outcomes Fol lowing TAVR in Younger (<75 Years) Low Surgical Risk Severe Aortic Stenosis Patients. Circ Cardiovasc Interv. 2024;(11):e014018. doi:10.1161/CIRCINTERVENTIONS.124.014018.

3. Stefanini GG, Panico C. CAD in TAVI patients: relevance of disease complexity. EuroIntervention. 2015;(4):373-5. doi:10.4244/EIJV11I4A76.

4. Faroux L, Lhermusier T, Vincent F, et al. ST-Segment Elevation Myocardial Infarction Following Transcatheter Aortic Valve Replacement. JACC. 2021;77(17):2187-99. doi:10.1016/j.jacc.2021.03.014.

5. Valvo R, Costa G, Tamburino C, Barbanti M. Coronary artery can nulation after transcatheter aortic valve Implantation. EuroIntervention. 2021;17:835-47. doi:10.4244/EIJ-D-21-00158.

6. Barbarash OL, Karpov YuA, Panov AV, et al. 2024 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2024;29(9):6110. (In Russ.) doi:10.15829/1560-4071-2024-6110.

7. Stefanini GG, Stortecky S, Meier B, et al. Severe aortic stenosis and coronary artery disease. EuroIntervention. 2013;9 Suppl:S63-8. doi:10.4244/EIJV9SSA12.

8. Nazif TM, Dizon JM, Hahn RT, et al. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv. 2015;8(1 Pt A):60-9. doi:10.1016/j.jcin.2014.07.022.

9. Hahn RT, Kodali S, Généreux P, et al. Paravalvular regurgitation following transcutaneous aortic valve replacement: predictors and clinical significance. Curr Cardiol Rep. 2014;16(5):475. doi:10.1007/s11886-014-0475-6.