# Simultaneous Cardioflow Optimisation to facilitate haemodynamic recovery after rapid ventricular pacing during transcatheter aortic valve implantation: a case series

## TL;DR

A new technique called 'Simultaneous CardioFlow optimization' helps improve blood flow recovery after heart procedures in high-risk patients.

## Contribution

The novel approach combines rapid ventricular pacing with coronary angioplasty to enhance hemodynamic recovery in complex heart cases.

## Key findings

- Two high-risk patients showed improved hemodynamics after the new technique was applied.
- The method was well-tolerated and led to uncomplicated hospital stays.
- The approach is effective for patients with severe left main trunk stenosis and aortic stenosis.

## Abstract

‘Simultaneous CardioFlow optimization’ represents an innovative technique that effectively enhances post-pacing haemodynamic recovery during transcatheter aortic valve replacement. This technique was applied in two high-risk patients presenting with severe left main trunk stenosis with concomitant severe aortic stenosis (AS) and left ventricular dysfunction (LVD).

An 86-year-old and a 96-year-old patient were admitted with myocardial infarction. Angiography revealed severe left main trunk stenosis, while echocardiography demonstrated significant LVD and severe AS. Both cases were evaluated by the institutional multidisciplinary heart team. Considering the high surgical risk, a percutaneous management strategy was contemplated.

We postulated that performing left main trunk balloon angioplasty during rapid ventricular pacing would be better tolerated, compared with conventional balloon angioplasty, given the low coronary perfusion pressure at this stage. Additionally, coronary balloon angioplasty is expected to enhance coronary flow in the immediate post-pacing period, thus facilitating haemodynamic recovery. Both patients exhibited prompt improvement in hemodynamics following rapid ventricular pacing and had uncomplicated hospital stays. In patients with significant left main trunk stenosis accompanied by severe AS and concomitant left ventricular dysfunction, ‘simultaneous CardioFlow optimisation’ facilitates post-pacing haemodynamic recovery.