{
    "abstract": "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.\nWe 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.\nWe 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.\nThis case highlights the importance of prompt recognition, hemodynamic stabilization with venoarterial extracorporeal membrane oxygenation, and emergent percutaneous coronary intervention in managing CAO post-TAVR.",
    "authors": [
        {
            "affiliation": "Internal Medicine Residency Program, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA; Cardiovascular Disease Fellowship Program, HCA Houston Healthcare-Kingwood/University of Houston College of Medicine, Houston, Texas, USA.",
            "firstname": "Hafez",
            "initials": "H",
            "lastname": "Golzarian"
        },
        {
            "affiliation": "University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.",
            "firstname": "Abdelrahman",
            "initials": "A",
            "lastname": "Osman"
        },
        {
            "affiliation": "Structural Heart & Intervention Center, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA.",
            "firstname": "Anna C",
            "initials": "AC",
            "lastname": "Kleman"
        },
        {
            "affiliation": "Structural Heart & Intervention Center, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA.",
            "firstname": "Mallory",
            "initials": "M",
            "lastname": "Knous"
        },
        {
            "affiliation": "Structural Heart & Intervention Center, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA.",
            "firstname": "Janelle M",
            "initials": "JM",
            "lastname": "Fields"
        },
        {
            "affiliation": "Structural Heart & Intervention Center, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA.",
            "firstname": "Andrew H",
            "initials": "AH",
            "lastname": "Macke"
        },
        {
            "affiliation": "Structural Heart & Intervention Center, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA.",
            "firstname": "Emily",
            "initials": "E",
            "lastname": "Shappell"
        },
        {
            "affiliation": "Department of Critical Care, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA.",
            "firstname": "Amanda D",
            "initials": "AD",
            "lastname": "Laird"
        },
        {
            "affiliation": "Department of Critical Care, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA.",
            "firstname": "William C",
            "initials": "WC",
            "lastname": "Cole"
        },
        {
            "affiliation": "Department of Cardiothoracic Surgery, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA.",
            "firstname": "John",
            "initials": "J",
            "lastname": "Sirak"
        },
        {
            "affiliation": "Structural Heart & Intervention Center, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA. Electronic address: SMPatel@mercy.com.",
            "firstname": "Sandeep M",
            "initials": "SM",
            "lastname": "Patel"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2025 The Authors. Published by Elsevier Inc. All rights reserved.",
    "doi": "10.1016/j.jaccas.2024.103200\n10.1016/j.jacc.2018.01.066\n10.1016/j.jcin.2012.11.014\n10.1161/CIRCINTERVENTIONS.114.002079",
    "journal": "JACC. Case reports",
    "keywords": [
        "aortic valve replacement",
        "cardiogenic shock",
        "coronary",
        "hemodynamics",
        "mechanical circulatory support"
    ],
    "methods": null,
    "publication_date": "2025-03-22",
    "pubmed_id": "40118636\n29622157\n23602458\n25593122\n34316942\n34917960\n31202947\n31272667",
    "results": null,
    "title": "Valve-in-Valve TAVR Complicated by Left Main Coronary Obstruction Salvaged by Left Atrial VA-ECMO.",
    "xml": "<Element 'PubmedArticle' at 0x7885044372e0>"
}