Two-in-one: Combined transcatheter therapy for hypertrophic cardiomyopathy and aortic stenosis

Abstract

Technical advancements together with robust clinical trial evidence continue to extend the reach of transcatheter therapies. Conditions once considered amenable only to surgery, are now treatable percutaneously offering not only safe outcomes, but in some cases, superior results. Whilst ongoing clinical trials will inform which patients are likely to benefit from either approach, safe transcatheter alternatives have been transformative for patients considered unfit for surgery. We present a case from our institution of a septuagenarian with both aortic stenosis and hypertrophic cardiomyopathy deemed unfit for surgery by a porcelain aorta. Alcohol septal ablation (ASA) and transcatheter aortic valve replacement (TAVR) were offered, however in the context of treatment for active malignancy, a previously planned staged intervention had to be performed in a single procedure due to the development of heart failure symptoms. We present the first description of this ‘two-in-one’ intervention and provide background literature review for both ASA and TAVR.

Keywords

• Aortic stenosis
• Hypertrophic cardiomyopathy
• Alcohol septal ablation
• Transcatheter aortic valve replacement