The Journal of invasive cardiology · 2026
Cardiopulmonary bypass is safe and effective support for concomitant high-risk percutaneous coronary intervention and transcatheter aortic valve replacement.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Gomez Axel, Matthews Madison E, Grober Aaron, Ferreira Ryan, Shunk Kendrick A, Zimmet Jeffrey, Tseng Elaine E, Boskovski Marko T
Аннотация
OBJECTIVES: Patients with coexisting severe aortic stenosis (AS) and critical coronary artery disease (CAD) face high procedural risk when treated percutaneously. Although mechanical circulatory support (MCS) can mitigate hemodynamic instability, evidence guiding the use of cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) during concomitant transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) is lacking.
METHODS: The authors retrospectively reviewed 6 high-risk patients who underwent concomitant TAVR and PCI with planned MCS using CPB or venoarterial (VA)-ECMO between 2015 and 2023. Outcomes were classified according to VARC-3 criteria.
RESULTS: Six male patients (mean age 77.3 ± 8.3 years) underwent concomitant TAVR and PCI with planned MCS using CPB (n = 4, 2015-2020) or VA-ECMO (n = 2, 2022-2023). Complete coronary revascularization was achieved in 4 cases (66.7%). Implanted valves included 2 self-expanding and 4 balloon-expandable prostheses. The mean catheter-measured transaortic gradient decreased from 37.2 ± 17.6 mm Hg to 3.9 ± 2.1 mm Hg (P = .006). Trace (1+) paravalvular leak occurred in 4 patients (66.7%), with none 2+ or higher. There were no intraprocedural complications, neurologic events, major bleeding, vascular complications, or 30-day deaths. Three patients (50%) developed new conduction abnormalities, all without pacemaker requirement. Acute kidney injury occurred in 3 (Stage I, 50%). The mean intensive care and total hospital stays were 5.5 ± 3.5 and 8.3 ± 6.0 days, respectively.
CONCLUSIONS: Planned CPB or VA-ECMO support enabled safe performance of concomitant TAVR and PCI in non-surgical, high-risk patients, representing a feasible approach for selected complex cases.
METHODS: The authors retrospectively reviewed 6 high-risk patients who underwent concomitant TAVR and PCI with planned MCS using CPB or venoarterial (VA)-ECMO between 2015 and 2023. Outcomes were classified according to VARC-3 criteria.
RESULTS: Six male patients (mean age 77.3 ± 8.3 years) underwent concomitant TAVR and PCI with planned MCS using CPB (n = 4, 2015-2020) or VA-ECMO (n = 2, 2022-2023). Complete coronary revascularization was achieved in 4 cases (66.7%). Implanted valves included 2 self-expanding and 4 balloon-expandable prostheses. The mean catheter-measured transaortic gradient decreased from 37.2 ± 17.6 mm Hg to 3.9 ± 2.1 mm Hg (P = .006). Trace (1+) paravalvular leak occurred in 4 patients (66.7%), with none 2+ or higher. There were no intraprocedural complications, neurologic events, major bleeding, vascular complications, or 30-day deaths. Three patients (50%) developed new conduction abnormalities, all without pacemaker requirement. Acute kidney injury occurred in 3 (Stage I, 50%). The mean intensive care and total hospital stays were 5.5 ± 3.5 and 8.3 ± 6.0 days, respectively.
CONCLUSIONS: Planned CPB or VA-ECMO support enabled safe performance of concomitant TAVR and PCI in non-surgical, high-risk patients, representing a feasible approach for selected complex cases.