Clinical Outcomes of Concurrent Impella-Assisted High-Risk PCI and TAVR in Patients With Complex Coronary Artery Disease and Severe Aortic Stenosis

Abstract

Background

Percutaneous management of high risk, percutaneous coronary intervention (PCI) needing mechanical support for complex coronary artery disease in patients needing transcatheter aortic valve replacement for severe aortic stenosis remains incompletely defined. We report on the feasibility and safety of a single-session strategy using Impella-assisted complex high-risk PCI (IA-CHIP) followed by transcatheter aortic valve replacement (TAVR).

Methods

We conducted a multicenter retrospective study of consecutive patients undergoing simultaneous IA-CHIP and TAVR at 3 tertiary centers between January 2015 and March 2026. All patients received mechanical circulatory support with percutaneous microaxial flow pump Impella CP (Abiomed) during PCI, followed by transfemoral TAVR in the same session. Baseline demographics, procedural characteristics, and clinical outcomes were collected. The primary endpoint was in-hospital complications, including death, stroke, major bleeding (Bleeding Academic Research Consortium types 2, 3, or 5), acute kidney injury, permanent pacemaker implantation, and vascular complications.

Results

A total of 12 patients were included (median age, 79.5 years [IQR, 77.0-81.2]; 91.7% male; median Charlson Comorbidity Index of 7 [IQR, 5.8-9]). Coronary lesions mainly involved left main disease in 66% of cases. Advanced calcium modification was required in 50% of cases. The median aortic valve area was 0.86 cm², and median mean gradient was 38 mm Hg. Procedural success for IA-CHIP and TAVR was 100%. There were no in-hospital deaths, strokes, or major vascular complications. Conduction disturbances requiring permanent pacemaker implantation occurred in 25%. An acute kidney injury occurred in 16.7% of cases, with no requirement for dialysis. The majority of patients (91.7%) were discharged home.

Conclusions

A single-session strategy of IA-CHIP followed by TAVR is feasible and safe in selected patients with complex coronary artery disease and severe aortic stenosis.