Simultaneous Cardioflow Optimisation to facilitate haemodynamic recovery after rapid ventricular pacing during transcatheter aortic valve implantation: a case series

Background ‘Simultaneous CardioFlow optimization’ represents an innovative technique that effectively enhances post-pacing haemodynamic recovery during transcatheter aortic valve replacement. This technique was applied in two high-risk patients presenting with severe left main trunk stenosis with concomitant severe aortic stenosis (AS) and left ventricular dysfunction (LVD). Case summary An 86-year-old and a 96-year-old patient were admitted with myocardial infarction. Angiography revealed severe left main trunk stenosis, while echocardiography demonstrated significant LVD and severe AS. Both cases were evaluated by the institutional multidisciplinary heart team. Considering the high surgical risk, a percutaneous management strategy was contemplated. Discussion We postulated that performing left main trunk balloon angioplasty during rapid ventricular pacing would be better tolerated, compared with conventional balloon angioplasty, given the low coronary perfusion pressure at this stage. Additionally, coronary balloon angioplasty is expected to enhance coronary flow in the immediate post-pacing period, thus facilitating haemodynamic recovery. Both patients exhibited prompt improvement in hemodynamics following rapid ventricular pacing and had uncomplicated hospital stays. In patients with significant left main trunk stenosis accompanied by severe AS and concomitant left ventricular dysfunction, ‘simultaneous CardioFlow optimisation’ facilitates post-pacing haemodynamic recovery.