Left Main Coronary Occlusion During TAVI Procedure: Calcium Embolization Matters

Acute coronary occlusion during transcatheter aortic valve implantation (TAVI) is an unwarranted complication associated with high mortality. The current TAVI practices recommend a multidetector computed tomography (MDCT) evaluation of the aortic valve, the left ventricular outflow tract, and the aortic root to determine the conventional risk factors for coronary obstruction like low-lying coronary ostia and narrow sinuses of Valsalva, mandating prophylactic coronary protection or native valve leaflet modification in high-risk patients. Despite optimal anatomy, acute coronary occlusion can still occur due to multiple mechanisms, one of which is coronary embolism due to thrombus, calcium, or native aortic valve fragments. A sudden hemodynamic collapse during a TAVI procedure in the absence of apparent causes always raises the suspicion of coronary occlusion, which requires a prompt percutaneous coronary intervention (PCI) to save the patient's life. This report describes a case of acute coronary occlusion during TAVI in a seemingly low-risk patient salvaged with an emergent left main (LM) bifurcation PCI.