Combined percutaneous treatment of severe aortic stenosis and left main disease in a high surgical risk patient.

We report the case of a 77-year-old man with heart failure (NYHA class IV), angina (CCS class III) and multiple comorbidities. The evaluation showed severe aortic sten osis and left main coronary disease. Due to the very high perioperative risk, conventional surgery was denied. It was therefore decided to perform a combined percutaneous intervention. First, left main PCI was successfully performed. A few days later, a percutaneous aortic valve prosthesis was implanted via a femoral approach using the CoreValve ReValving system. Immediately after prosthesis implantation, the control angiogram showed severe paravalvular aortic regurgitation, which was corrected by implanting another percutaneous aortic prosthesis inside the first one (valve-in-valve procedure). During follow-up the patient experienced a remarkable improvement in hemodynamic and clinical status. We demonstrate that the combination of two different percutaneous interventions in severe aortic and coronary disease is feasible and can be a suitable alternative approach in high surgical risk patients.