Balloon Aortic Valvuloplasty Followed by Impella®-Assisted Left Main Coronary Artery Percutaneous Coronary Intervention in PatientsWith Severe Aortic Stenosis as a Bridge to Transcatheter Aortic Valve Replacement

Background: The use of Impella (R) to provide hemodynamic support during unprotected left main coronary artery (LMCA) percutaneous coronary intervention (PCI) has been shown to be feasible, but severe AS is a relative contraindication for its use. Balloon aortic valvuloplasty (BAV) may facilitate the use of Impella (R) in these patients. Objective: To assess the feasibility of BAV followed by Impella (R)-assisted LMCA PCI in patients with severe AS as bridge to TAVR. Methods: Patients with symptomatic severe AS with LMCA stenosis >= 70% requiring PCI prior to TAVR were included. Outcomes were retrospectively collected. Results: Seven patients underwent BAV followed by Impella (R)-assisted LMCA PCI. Five patientswere male; mean age 86 (75-91; SD +/- 5.5). Mean STS scorewas 6.5% (4.3-13.8; SD +/- 3.4). Impella (R) 2.5 Lwas used in all cases. The procedure was successful in all patients without peri-procedure complications. At 30-day post-BAV/PCI follow up, all patients had experienced improvement in NYHA class (N = 2 NYHA IV to III, N = 5 NYHA III to II). At such interval, mean EF was 54% (30-77; SD +/- 17.7). The post BAV change in AVA [0.8 cm(2) (0.4-1.5; SD +/- 0.3; P = 0.07)], and AV mean gradient [30.8 mmHg (21-45; SD +/- 8.9; P = 0.95)] after the procedure were not statistically significant. All patients underwent TAVR after amedian PCI-to-TAVR interval of 62 days (33-339; SD +/- 96.7). Conclusions: BAV followed by Impella (R)-assisted LMCA PCI appears to be a feasible strategy for intermediate and high surgical risk patients with severe AS undergoing LMCA PCI as bridge to TAVR. (C) 2020 Elsevier Inc. All rights reserved.