Combined Percutaneous Coronary Intervention and Transcatheter Aortic Valve Implantation in Cardiogenic Shock

Transcatheter aortic valve implantation (TAVI) is a therapeutic option for patients with severe aortic valve stenosis and high surgical risk. Data concerning combined TAVI and percutaneous coronary intervention (PCI) as an alternative treatment to surgery in high-risk patients with aortic valve stenosis and concomitant coronary artery disease (CAD) are limited, and no prior cases of an emergency procedure in cardiogenic shock have been described. Herein is presented the case of a 53-year-old patient admitted in cardiogenic shock due to subacute myocardial infarction as well as high-grade aortic valve disease. Because of a prior history of mediastinal irradiation and the patient's unstable condition, an immediate percutaneous procedure was successfully performed with sequential transfemoral PCI and TAVI. The patient gradually recovered with a markedly improved left ventricular function and good quality of life. In conclusion, a single-stage combined approach is reasonable even in an emergency setting, and can lead to a good short-term outcome. However, further reports and experience are needed to evaluate the feasibility of this approach.