Transcarotid TAVI with left carotid-subclavian bypass for the management of refractory angina

Abstract

New transcatheter and endovascular techniques have transformed cardiac surgery operating rooms into collaborative spaces where multidisciplinary teams address
complex cases.
In the patient we present, surgical revascularization was performed; the patient then developed progressive angina with electrocardiographic changes in the anterior wall.
Coronary angiography showed patent grafts and no progression of native coronary artery disease. Computed tomography revealed a calcified plaque at the origin of the
left subclavian artery.
Endovascular treatment was performed using a covered stent proximal to the mammary artery. Despite this, refractory angina persisted, and further angioplasties were necessary, with no improvement in the vascular lumen. Additionally, echocardiography showed worsening of a preexisting aortic stenosis.
A multidisciplinary approach was chosen, involving a left transcarotid self-expanding transcatheter aortic valve implantation (TAVI) and concomitant carotid-subclavian bypass, using an alternative technique to achieve optimal annular alignment via a contralateral support balloon.