Valve-in-Valve TAVR Complicated by Left Main Coronary Obstruction Salvaged by Left Atrial VA-ECMO.

Background: Coronary artery obstruction (CAO) is a life-threatening complication of valve-in-valve transcatheter aortic valve replacement (TAVR) often necessitating expeditious intervention and hemodynamic support.

Methods: We present the case of a patient undergoing valve-in-valve TAVR who endured cardiac arrest secondary to CAO due to leaflet impingement, necessitating immediate venoarterial extracorporeal membrane oxygenation support. Subsequent percutaneous coronary intervention using a workhorse guidewire and stent successfully restored coronary flow.

Conclusions: We describe an order of operations protocol used at our center for such cases elucidating the logistics and implementation of the strategy that allowed for successful resuscitation of our patient. The increasing complexity of TAVR procedures necessitates proceduralists' familiarity with advanced bailout techniques and multidisciplinary team approaches to address such critical complications. Conclusions: This case highlights the importance of prompt recognition, hemodynamic stabilization with venoarterial extracorporeal membrane oxygenation, and emergent percutaneous coronary intervention in managing CAO post-TAVR.