MoyoAssist® Supports Single-Selection TAVR-PCI in a High-Risk Elderly Patient

A multidisciplinary team at Xi'an No.1 Hospital recently completed a minimally invasive simgle- selection transapical transcatheter aortic valve replacement (TA-TAVR) and complex percutaneous coronary intervention (PCI) procedure in an 83-year-old high-risk patient, with hemodynamic support provided by the MoyoAssist®  system. This case highlights the potential of MoyoAssist® in elderly patients with multiple comorbidities, offering new options for managing complex cardiovascular disease.

Patient Profile

Age: 83

Gender: Male

Medical History:  

• 4-month history of intermittent chest tightness and dyspnea, worsened by bilateral lower limb edema over the preceding two days. 

Symptoms: 

• Admitted with acute myocardial infarction and acute left heart failure. 

• After stabilization with medical therapy, coronary angiography revealed triple-vessel disease, including severe (>85%) proximal right coronary artery stenosis and complex left main trifurcation lesions.

Key Findings

Echocardiography: Severe aortic regurgitation (regurgitation area: 9.0 cm²), left ventricular ejection fraction (LVEF) ~30%, left ventricular enlargement (LVEDD 69 mm), and mild regurgitation across mitral, tricuspid, and pulmonary valves.

Chest X-ray: Pulmonary congestion with signs of infection.

CT Assessment: Aortic annulus diameter 27.7 mm with large outflow tract; unsuitable for self-expanding valve, thus a 29 mm balloon-expandable valve was selected for transapical implantation.

Diagnoses

• Non-ST elevation myocardial infarction (NSTEMI)

• Ischemic cardiomyopathy

• Killip Class III heart failure

• Severe aortic regurgitation

• Hypertension (grade 3, very high risk)

• Chronic obstructive pulmonary disease (COPD)

• Hypothyroidism

• Pulmonary infection

• Peripheral arterial disease

Procedure Strategy

Given the patient's age, severe cardiac dysfunction, and refusal of open-heart surgery, the team opted for a single-selection minimally invasive approach with MoyoAssist® support. The procedure involved:

1.Percutaneous insertion of MoyoAssist®

• Venous drainage via left superior pulmonary vein (accessed through femoral vein and atrial septum)

• Arterial return via left femoral artery

• Initial flow rate: 2 L/min

2.TA-TAVR

• Transapical valve implantation via a small thoracotomy at the fifth intercostal space

• Aortic regurgitation resolved intraoperatively with stable hemodynamics

3.PCI under MoyoAssist® support

• Complex left main bifurcation lesion addressed

• Following LAD pre-dilation, rotational branch flow dropped, requiring sequential management

• Two episodes of intraoperative cardiac arrest occurred but were stabilized with VAD support

Postoperative Course

Following surgery, the patient was transferred to the ICU with MoyoAssist® support due to circulatory instability during weaning attempts. By postoperative day 3, cardiac function had improved significantly. Pericardial effusion was managed effectively, and the device was successfully removed. The patient ambulated on postoperative day 4 with favorable recovery indicators.

Clinical Insights

This case underscores the value of MoyoAssist® in supporting high-risk structural and coronary interventions. Key advantages observed:

• Intraoperative Support: Maintained hemodynamic stability and reduced cardiac workload during complex interventions

• Left Ventricular Unloading: Facilitated myocardial recovery during the critical perioperative period

• Early Recovery: Significant functional improvement within 3 days, with the patient eating, sitting, and walking within 4 days post-op

• Precision Support: Compared to ECMO, standalone VAD configuration offers more targeted circulatory support and improved tissue perfusion

The success of this case highlights a viable and efficient treatment pathway for elderly, high-risk patients who are unsuitable for traditional surgical approaches. The integrated efforts of cardiology, cardiac surgery, anesthesia, and imaging teams were essential in surgical planning, risk assessment, intraoperative management, and postoperative recovery—emphasizing the critical role of multidisciplinary collaboration in complex cardiovascular care.

For more information about MoyoAssist®, please vistit https://en.magassist.tech/MoyoAssist-Extra-VAD/