TAVI and coronary artery disease - LIVE case

An 88-year-old woman with hypertension, dyslipidemia, paroxysmal AF, and moderate renal impairment presented with symptomatic severe aortic stenosis, with a small (396 mm²), horizontal annulus and preserved LV function. She also had CAD with severe OM and diagonal stenoses. CT showed a risk of left main occlusion.A Sapien 3 Ultra 23 mm valve was implanted under local anesthesia, with 2 cc overfilling and double TAP. Right femoral access was used, along with two radial accesses: right radial for left main protection (JL3.5 catheter and wire in the LAD) and left radial as secondary access. Closure was performed using ProStyle and Angio-Seal.

LIVE Educational Case from Clinique Pasteur - Toulouse, France

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Key moments

• 25:26-28:50 - CT analysis
• 35:16-42:51 - femoral access echoguided and preclosure
• 42:58-44:50 - left main protection
• 51:10-1:00:25 - valve implantation
• 1:02:10-1:05:40 - control hemodynamic and angio
• 1:08:55-1:12:22 - femoral closure and control echo
• 1:14:00-1:16:09 - procedural analysis

Keywords: Aortic Stenosis, Sapien 3 Ultra, small annulus, left main protection, femoral access, femoral closure