Perfusion Balloon Is Useful for Preventing Obstruction of Left Main Coronary Artery During Transcatheter Aortic Valve Implantation

• Published in: International Heart Journal Vol. 63; no. 1; pp. 163 - 167
• Main Authors: Hashimoto, Naoto, Tamura, Harutoshi, Otaki, Yoichiro, Takahata, Aoi, Tsuchiya, Hayato, Sugai, Takayuki, Yamashita, Atsushi, Wanezaki, Masahiro, Nishiyama, Satoshi, Watanabe, Tetsu, Uchida, Tetsuro, Watanabe, Masafumi
• Format: Journal Article
• Language: English
• Published: Japan International Heart Journal Association 29.01.2022; Japan Science and Technology Agency
• Subjects: Aged, 80 and over; Anesthesia; Angioplasty, Balloon, Coronary - instrumentation; Aortic stenosis; Aortic valve; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Balloon treatment; Computed tomography; Coronary artery; Coronary Occlusion - etiology; Coronary Occlusion - prevention & control; Coronary protection; Female; Femoral artery; Hemodynamics; Humans; Ischemia; Perfusion; Syncope; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Transcatheter Aortic Valve Replacement - methods; Veins & arteries; Ventricle; Aortic stenosis; Coronary protection
• ISSN: 1349-2365; 1349-3299
• DOI: 10.1536/ihj.21-275

The incidence of acute coronary obstruction during transcatheter aortic valve implantation (TAVI) is low (< 1.0%); however, it is associated with high mortality. An 83-year-old female with a history of chest pain and syncope was diagnosed with severe aortic stenosis. Computed tomography showed severely calcified aortic leaflets with a low left coronary ostial height of 7.8 mm, which indicates a high risk of coronary obstruction. TAVI was performed using the right femoral artery approach under general anesthesia. To prevent coronary obstruction and minimize coronary flow obstruction, coronary protection of the left main tract (LMT) via the left radial artery was established with a perfusion balloon. We crossed a 23 mm Sapien 3 transcatheter heart valve and settled it at an appropriate position on the aortic valve. After inflation of the perfusion balloon at the LMT, we started rapid ventricular pacing, and deployed the Sapien 3 using the KBI technique. Hemodynamics were stable and aortography showed excellent coronary flow with no stenosis of the LMT ostium. This strategy may serve as a useful method to prevent coronary obstruction and minimize coronary ischemia.