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The right heart chambers were non-dilated&#44; with mild pulmonary hypertension of 45 mmHg&#44; and the mitral valve showed normal morphology and function&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A previous nuclear stress test performed by the primary care provider before the diagnosis of aortic stenosis revealed a large area of inferior wall ischemia&#46; Consequently&#44; we scheduled an invasive coronary angiogram with left and right heart catheterization&#44; which showed a heavily calcified ostial right coronary artery obstructive lesion of 99&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41; combined with critical aortic stenosis &#40;mean transaortic PG of 44 mmHg and an AVA of 0&#46;3 cm<span class="elsevierStyleSup">2</span>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Taking into consideration her overall functional condition&#44; comorbidities and a Society of Thoracic Surgeons &#40;STS&#41; score of 12&#37;&#44; our multidisciplinary team concluded that a transcatheter approach was preferable to open heart surgery&#46; We elected to perform a high-risk percutaneous intervention of the RCA with BAV as a bridge to a staged TAVR&#46; Due to the RCA complexity&#44; requiring an important volume of contrast for PCI&#44; we decided to proceed for a staged PCI of the RCA combined with balloon aortic valvuloplasty &#40;BAV&#41;&#44; followed by TAVR after recovery&#46; We felt that this approach would limit the amount of contrast used and would allow conscious sedation and the use of smaller sheaths&#46; We anticipated that the first stage would temporarily improve the patient&#39;s angina and functional class for a safer second-stage ad-hoc TAVR procedure&#46; At the same time&#44; in the event of hemodynamic instability during rotational atherectomy or BAV&#44; bail-out emergent TAVR or open surgery could be performed in our hybrid lab&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A 7 French &#40;F&#41; sheath was placed in the left common femoral artery &#40;CFA&#41;&#44; after preclosure with two Perclose ProGlide suture-mediated closure systems &#40;Abbott Vascular&#44; Abbott Park&#44; IL&#41; and a 6F sheath in the right femoral vein&#46; A 7F JR4 guiding catheter with side holes was placed in the ostium of the RCA and a 6F temporary pacemaker lead was positioned and secured in the right ventricle&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The RCA lesion was crossed with a RotaWire Floppy Guide Wire &#40;Boston Scientific&#44; Natick&#44; MA&#41;&#44; which was advanced to the distal RCA&#46; Rotational atherectomy was performed with several passes of a 1&#46;5 mm burr&#46; During rotational atherectomy we aimed to maintain the patient&#39;s heart rate 15&#8211;20 bpm above resting heart rate to prevent any potential bradycardia and subsequent hypotension&#46; A 3&#46;0 mm&#215;12 mm Resolute drug-eluting stent &#40;DES&#41; &#40;Medtronic&#44; Minneapolis&#44; USA&#41; was deployed in the ostium of the RCA at 18 atm and post-dilated with a 3&#46;5 mm&#215;12 mm non-compliant balloon&#44; with an excellent angiographic result &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">After completion of the coronary intervention&#44; the 7F arterial sheath was upsized to an 11F sheath&#46; The aortic valve was crossed with an AL-1 diagnostic catheter and a soft straight 0&#46;035&#8243; guide wire which was then exchanged for an Amplatz Super Stiff wire &#40;St&#46; Jude&#44; St&#46; Paul&#44; MN&#41;&#46; BAV was performed with a 20 mm Loma Vista balloon &#40;Loma Vista Medical Inc&#46;&#41; under rapid pacing &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Postvalvuloplasty hemodynamics revealed a residual mean gradient of 23 mmHg and an estimated aortic valve area of 0&#46;56 cm<span class="elsevierStyleSup">2</span>&#46; The procedure was then terminated with no immediate or late complications&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The patient remained asymptomatic until a successful TAVR procedure four weeks later&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Patients with obstructive coronary artery disease and severe aortic stenosis have traditionally been managed with open heart surgery&#46; In the era of TAVR and high-risk coronary interventions many of those patients who were previously considered &#8220;terminal&#8221; can now be successfully managed with PCI and TAVR&#46; The medical literature on the optimal transcatheter management of such cases is scant and the appropriate approach and strategy are unclear&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In the absence of randomized control trials &#40;RCTs&#41;&#44; as the only RCT involving TAVR &#40;the PARTNER trial&#41; excluded patients with obstructive CAD&#44; data from registries and case series clearly show significant increased long-term mortality in patients with combined CAD and AS&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Although the role of BAV as a definitive treatment is now limited&#44; it remains an acceptable bridge to SAVR or TAVR in patients who are not immediately suitable for permanent treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The optimal timing of each procedure also remains unclear&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">9&#44;10</span></a> Pedersen et al&#46; suggested that BAV with PCI may be as safe as BAV alone in selected patients&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In a large retrospective cohort study&#44; Goel et al&#46; showed that PCI in patients with severe symptomatic AS does not increase the risk of short-term mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> However&#44; in patients with ejection fraction &#60;30&#37; or STS score &#62;10&#37;&#44; increased 30-day mortality after PCI was seen&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In a smaller case series&#44; Salhab et al&#46; demonstrated the feasibility and safety of PCI and TAVR in the same procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> In the real world&#44; due to fluoroscopy time and contrast volume limitations&#44; such an approach is reserved for patients with simple PCIs and without anticipated important hemodynamic compromise&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The safety of rotational atherectomy in patients with severe aortic stenosis has not been well established&#46; Combined rotational atherectomy and BAV have been previously reported as separate staged procedures or in the same procedure with hemodynamic support devices&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">We present the first case report of combined rotational atherectomy with BAV as a bridge to TAVR in a frail patient with symptomatic combined obstructive CAD and critical AS who was deemed inoperable&#46; Although we did not use hemodynamic support devices&#44; we elected for temporary pacing at higher heart rates during rotational atherectomy to prevent atherectomy-induced bradycardia and hypotension&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The optimal management of inoperable patients with obstructive CAD and severe AS remains unclear&#46; In cases with high-risk coronary lesions&#44; PCI with BAV may represent a reasonable first procedure as a bridge to TAVR&#46; Our case report&#44; the first of its kind&#44; of combined rotational atherectomy and BAV without hemodynamic support shows that high-risk coronary interventions are feasible in patients with critical AS with careful planning&#46; Larger studies are needed to define the best transcatheter approach and strategies&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O grupo de doentes com doen&#231;a coron&#225;ria obstrutiva e estenose a&#243;rtica grave foi tratado&#44; conforme &#233; habitual&#44; com cirurgia de cora&#231;&#227;o aberto&#46; Na era de substitui&#231;&#227;o valvular a&#243;rtica percut&#226;nea &#40;TAVR&#41; e das interven&#231;&#245;es coron&#225;rias de alto risco&#44; muitos daqueles doentes que foram previamente considerados &#171;terminais&#187;&#44; podem agora ser tratados com sucesso com interven&#231;&#227;o coron&#225;ria percut&#226;nea &#40;ICP&#41; e com TAVR&#46; Embora a simples ICP possa ser prudentemente combinada com a TAVR no mesmo procedimento&#44; as interven&#231;&#245;es coron&#225;rias de alto risco necessitam muitas vezes de ser efetuadas em separado&#46; Apresentamos o primeiro caso cl&#237;nico de aterectomia rotacional combinada com valvuloplastia a&#243;rtica com bal&#227;o como ponte para TAVR numa doente fr&#225;gil com doen&#231;a coron&#225;ria complexa e estenose a&#243;rtica cr&#237;tica&#46;</p></span>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:13 [
            0 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severe aortic stenosis and coronary artery disease &#8211; implications for management in the transcatheter aortic valve replacement era&#58; a comprehensive review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;S&#46; Goel"
                            1 => "M&#46; Ige"
                            2 => "E&#46;M&#46; Tuzcu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2013.01.096"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2013"
                        "volumen" => "62"
                        "paginaInicial" => "1"
                        "paginaFinal" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23644089"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "A7"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of coronary artery disease in patients with aortic stenosis with and without angina pectoris"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;H&#46; Rapp"
                            1 => "L&#46;D&#46; Hillis"
                            2 => "R&#46;A&#46; Lange"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2001"
                        "volumen" => "87"
                        "paginaInicial" => "1216"
                        "paginaFinal" => "1217"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11356405"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Frequency of angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Vandeplas"
                            1 => "J&#46;L&#46; Willems"
                            2 => "J&#46; Piessens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "1988"
                        "volumen" => "62"
                        "paginaInicial" => "117"
                        "paginaFinal" => "120"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3381731"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of cardiac surgery in patients &#62; or &#61; 80 years&#58; results from the National Cardiovascular Network"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46;P&#46; Alexander"
                            1 => "K&#46;J&#46; Anstrom"
                            2 => "L&#46;H&#46; Muhlbaier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2000"
                        "volumen" => "35"
                        "paginaInicial" => "731"
                        "paginaFinal" => "738"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10716477"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk index for predicting in-hospital mortality for cardiac valve surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;L&#46; Hannan"
                            1 => "C&#46; Wu"
                            2 => "E&#46;V&#46; Bennett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2006.09.051"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2007"
                        "volumen" => "83"
                        "paginaInicial" => "921"
                        "paginaFinal" => "929"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17307434"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary artery disease and its management&#58; influence on survival in patients undergoing aortic valve replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;J&#46; Mullany"
                            1 => "L&#46;R&#46; Elveback"
                            2 => "R&#46;L&#46; Frye"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1987"
                        "volumen" => "10"
                        "paginaInicial" => "66"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3496372"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognosis of valve replacement for aortic stenosis with or without coexisting coronary heart disease&#58; a comparative study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Iung"
                            1 => "M&#46;F&#46; Drissi"
                            2 => "P&#46;L&#46; Michel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Valve Dis"
                        "fecha" => "1993"
                        "volumen" => "2"
                        "paginaInicial" => "430"
                        "paginaFinal" => "439"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8269146"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
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                        "link" => array:1 [
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                        "link" => array:1 [
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                        "link" => array:1 [
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Case report
Combined rotational atherectomy and aortic balloon valvuloplasty as a bridge to transcatheter aortic valve replacementCombined rotational atherectomy and aortic balloon valvuloplasty
Aterectomia rotacional combinada e valvuloplastia aórtica com balão como ponte para substituição valvular aórtica percutânea
Omar Alia,
Corresponding author
aravalbw@hotmail.com

Corresponding author.
, Konstantinos Marmagkiolisb,c, Mehmet Cilingiroglud,e
a Wesley Medical Center, Wichita, KS, United States
b Citizens Memorial Hospital, Heart and Vascular Institute, Bolivar, MO, United States
c University of Missouri, Columbia, MO, United States
d Arkansas Heart Hospital, Little Rock, AR, United States
e Koc University, School of Medicine, Istanbul, Turkey
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    "titulo" => "Combined rotational atherectomy and aortic balloon valvuloplasty as a bridge to transcatheter aortic valve replacementCombined rotational atherectomy and aortic balloon valvuloplasty"
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        "titulo" => "Aterectomia rotacional combinada e valvuloplastia a&#243;rtica com bal&#227;o como ponte para substitui&#231;&#227;o valvular a&#243;rtica percut&#226;nea"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The combination of symptomatic obstructive coronary artery disease &#40;CAD&#41; and severe aortic stenosis &#40;AS&#41; accounts for 25&#8211;50&#37; of patients with severe AS and carries important morbidity and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1&#8211;3</span></a> The standard of care has traditionally been surgical aortic valve replacement &#40;SAVR&#41; with coronary artery bypass grafting &#40;CABG&#41;&#46; Although isolated SAVR generally carries a low surgical risk&#44; the additional need for CABG significantly raises surgical mortality&#44; especially in the frail and elderly population&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">4&#8211;6</span></a> Furthermore&#44; incomplete coronary artery revascularization in patients with SAVR is known to increase postoperative mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the era of transcatheter aortic valve replacement &#40;TAVR&#41; many patients with obstructive CAD and AS who are not candidates for surgery are referred for transcatheter management&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We present a case of complex obstructive CAD with critical AS&#44; treated with combined rotational atherectomy and aortic valvuloplasty as a bridge to TAVR&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">An 84-year-old female with severe symptomatic aortic stenosis was referred to our multidisciplinary team for possible SAVR or TAVR&#46; For the last six months she had experienced progressive angina &#40;Canadian Cardiovascular Society class III&#41; and dyspnea on exertion &#40;New York Heart Association class III&#41; with a recent episode of syncope which resulted in a forehead laceration and ecchymosis&#46; The patient was wheelchair-bound for more than two months due to the presence of activity-limiting symptoms&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Her transthoracic echocardiogram revealed a non-dilated left ventricle with preserved ejection fraction of 60&#37; and moderate concentric hypertrophy&#46; The aortic valve was trileaflet&#44; heavily calcified with a peak transaortic velocity of 5&#46;2 m&#47;s&#44; a mean pressure gradient &#40;PG&#41; of 55 mmHg&#44; a calculated aortic valve area &#40;AVA&#41; of 0&#46;37 cm<span class="elsevierStyleSup">2</span>&#44; an AVA index of 0&#46;26 cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> and absence of aortic insufficiency&#46; The right heart chambers were non-dilated&#44; with mild pulmonary hypertension of 45 mmHg&#44; and the mitral valve showed normal morphology and function&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A previous nuclear stress test performed by the primary care provider before the diagnosis of aortic stenosis revealed a large area of inferior wall ischemia&#46; Consequently&#44; we scheduled an invasive coronary angiogram with left and right heart catheterization&#44; which showed a heavily calcified ostial right coronary artery obstructive lesion of 99&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41; combined with critical aortic stenosis &#40;mean transaortic PG of 44 mmHg and an AVA of 0&#46;3 cm<span class="elsevierStyleSup">2</span>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Taking into consideration her overall functional condition&#44; comorbidities and a Society of Thoracic Surgeons &#40;STS&#41; score of 12&#37;&#44; our multidisciplinary team concluded that a transcatheter approach was preferable to open heart surgery&#46; We elected to perform a high-risk percutaneous intervention of the RCA with BAV as a bridge to a staged TAVR&#46; Due to the RCA complexity&#44; requiring an important volume of contrast for PCI&#44; we decided to proceed for a staged PCI of the RCA combined with balloon aortic valvuloplasty &#40;BAV&#41;&#44; followed by TAVR after recovery&#46; We felt that this approach would limit the amount of contrast used and would allow conscious sedation and the use of smaller sheaths&#46; We anticipated that the first stage would temporarily improve the patient&#39;s angina and functional class for a safer second-stage ad-hoc TAVR procedure&#46; At the same time&#44; in the event of hemodynamic instability during rotational atherectomy or BAV&#44; bail-out emergent TAVR or open surgery could be performed in our hybrid lab&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A 7 French &#40;F&#41; sheath was placed in the left common femoral artery &#40;CFA&#41;&#44; after preclosure with two Perclose ProGlide suture-mediated closure systems &#40;Abbott Vascular&#44; Abbott Park&#44; IL&#41; and a 6F sheath in the right femoral vein&#46; A 7F JR4 guiding catheter with side holes was placed in the ostium of the RCA and a 6F temporary pacemaker lead was positioned and secured in the right ventricle&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The RCA lesion was crossed with a RotaWire Floppy Guide Wire &#40;Boston Scientific&#44; Natick&#44; MA&#41;&#44; which was advanced to the distal RCA&#46; Rotational atherectomy was performed with several passes of a 1&#46;5 mm burr&#46; During rotational atherectomy we aimed to maintain the patient&#39;s heart rate 15&#8211;20 bpm above resting heart rate to prevent any potential bradycardia and subsequent hypotension&#46; A 3&#46;0 mm&#215;12 mm Resolute drug-eluting stent &#40;DES&#41; &#40;Medtronic&#44; Minneapolis&#44; USA&#41; was deployed in the ostium of the RCA at 18 atm and post-dilated with a 3&#46;5 mm&#215;12 mm non-compliant balloon&#44; with an excellent angiographic result &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">After completion of the coronary intervention&#44; the 7F arterial sheath was upsized to an 11F sheath&#46; The aortic valve was crossed with an AL-1 diagnostic catheter and a soft straight 0&#46;035&#8243; guide wire which was then exchanged for an Amplatz Super Stiff wire &#40;St&#46; Jude&#44; St&#46; Paul&#44; MN&#41;&#46; BAV was performed with a 20 mm Loma Vista balloon &#40;Loma Vista Medical Inc&#46;&#41; under rapid pacing &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Postvalvuloplasty hemodynamics revealed a residual mean gradient of 23 mmHg and an estimated aortic valve area of 0&#46;56 cm<span class="elsevierStyleSup">2</span>&#46; The procedure was then terminated with no immediate or late complications&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The patient remained asymptomatic until a successful TAVR procedure four weeks later&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Patients with obstructive coronary artery disease and severe aortic stenosis have traditionally been managed with open heart surgery&#46; In the era of TAVR and high-risk coronary interventions many of those patients who were previously considered &#8220;terminal&#8221; can now be successfully managed with PCI and TAVR&#46; The medical literature on the optimal transcatheter management of such cases is scant and the appropriate approach and strategy are unclear&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In the absence of randomized control trials &#40;RCTs&#41;&#44; as the only RCT involving TAVR &#40;the PARTNER trial&#41; excluded patients with obstructive CAD&#44; data from registries and case series clearly show significant increased long-term mortality in patients with combined CAD and AS&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Although the role of BAV as a definitive treatment is now limited&#44; it remains an acceptable bridge to SAVR or TAVR in patients who are not immediately suitable for permanent treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The optimal timing of each procedure also remains unclear&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">9&#44;10</span></a> Pedersen et al&#46; suggested that BAV with PCI may be as safe as BAV alone in selected patients&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In a large retrospective cohort study&#44; Goel et al&#46; showed that PCI in patients with severe symptomatic AS does not increase the risk of short-term mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> However&#44; in patients with ejection fraction &#60;30&#37; or STS score &#62;10&#37;&#44; increased 30-day mortality after PCI was seen&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In a smaller case series&#44; Salhab et al&#46; demonstrated the feasibility and safety of PCI and TAVR in the same procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> In the real world&#44; due to fluoroscopy time and contrast volume limitations&#44; such an approach is reserved for patients with simple PCIs and without anticipated important hemodynamic compromise&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The safety of rotational atherectomy in patients with severe aortic stenosis has not been well established&#46; Combined rotational atherectomy and BAV have been previously reported as separate staged procedures or in the same procedure with hemodynamic support devices&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">We present the first case report of combined rotational atherectomy with BAV as a bridge to TAVR in a frail patient with symptomatic combined obstructive CAD and critical AS who was deemed inoperable&#46; Although we did not use hemodynamic support devices&#44; we elected for temporary pacing at higher heart rates during rotational atherectomy to prevent atherectomy-induced bradycardia and hypotension&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The optimal management of inoperable patients with obstructive CAD and severe AS remains unclear&#46; In cases with high-risk coronary lesions&#44; PCI with BAV may represent a reasonable first procedure as a bridge to TAVR&#46; Our case report&#44; the first of its kind&#44; of combined rotational atherectomy and BAV without hemodynamic support shows that high-risk coronary interventions are feasible in patients with critical AS with careful planning&#46; Larger studies are needed to define the best transcatheter approach and strategies&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patients with obstructive coronary artery disease and severe aortic stenosis have traditionally been managed with open heart surgery&#46; In the era of transcatheter aortic valve replacement &#40;TAVR&#41; and high-risk coronary interventions many of those patients who were previously considered &#8220;terminal&#8221; can now be successfully managed with percutaneous coronary intervention &#40;PCI&#41; and TAVR&#46; Although simple PCI can be safely combined with TAVR in the same procedure&#44; high-risk coronary interventions often need to be performed separately&#46; We report the first case of combined rotational atherectomy with balloon aortic valvuloplasty as a bridge to TAVR in a frail patient with complex coronary artery disease and critical aortic stenosis&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O grupo de doentes com doen&#231;a coron&#225;ria obstrutiva e estenose a&#243;rtica grave foi tratado&#44; conforme &#233; habitual&#44; com cirurgia de cora&#231;&#227;o aberto&#46; Na era de substitui&#231;&#227;o valvular a&#243;rtica percut&#226;nea &#40;TAVR&#41; e das interven&#231;&#245;es coron&#225;rias de alto risco&#44; muitos daqueles doentes que foram previamente considerados &#171;terminais&#187;&#44; podem agora ser tratados com sucesso com interven&#231;&#227;o coron&#225;ria percut&#226;nea &#40;ICP&#41; e com TAVR&#46; Embora a simples ICP possa ser prudentemente combinada com a TAVR no mesmo procedimento&#44; as interven&#231;&#245;es coron&#225;rias de alto risco necessitam muitas vezes de ser efetuadas em separado&#46; Apresentamos o primeiro caso cl&#237;nico de aterectomia rotacional combinada com valvuloplastia a&#243;rtica com bal&#227;o como ponte para TAVR numa doente fr&#225;gil com doen&#231;a coron&#225;ria complexa e estenose a&#243;rtica cr&#237;tica&#46;</p></span>"
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                      "titulo" => "Severe aortic stenosis and coronary artery disease &#8211; implications for management in the transcatheter aortic valve replacement era&#58; a comprehensive review"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23644089"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "A7"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of coronary artery disease in patients with aortic stenosis with and without angina pectoris"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;H&#46; Rapp"
                            1 => "L&#46;D&#46; Hillis"
                            2 => "R&#46;A&#46; Lange"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2001"
                        "volumen" => "87"
                        "paginaInicial" => "1216"
                        "paginaFinal" => "1217"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11356405"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Frequency of angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Vandeplas"
                            1 => "J&#46;L&#46; Willems"
                            2 => "J&#46; Piessens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "1988"
                        "volumen" => "62"
                        "paginaInicial" => "117"
                        "paginaFinal" => "120"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3381731"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of cardiac surgery in patients &#62; or &#61; 80 years&#58; results from the National Cardiovascular Network"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46;P&#46; Alexander"
                            1 => "K&#46;J&#46; Anstrom"
                            2 => "L&#46;H&#46; Muhlbaier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2000"
                        "volumen" => "35"
                        "paginaInicial" => "731"
                        "paginaFinal" => "738"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10716477"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk index for predicting in-hospital mortality for cardiac valve surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;L&#46; Hannan"
                            1 => "C&#46; Wu"
                            2 => "E&#46;V&#46; Bennett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2006.09.051"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2007"
                        "volumen" => "83"
                        "paginaInicial" => "921"
                        "paginaFinal" => "929"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17307434"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary artery disease and its management&#58; influence on survival in patients undergoing aortic valve replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;J&#46; Mullany"
                            1 => "L&#46;R&#46; Elveback"
                            2 => "R&#46;L&#46; Frye"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1987"
                        "volumen" => "10"
                        "paginaInicial" => "66"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3496372"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognosis of valve replacement for aortic stenosis with or without coexisting coronary heart disease&#58; a comparative study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Iung"
                            1 => "M&#46;F&#46; Drissi"
                            2 => "P&#46;L&#46; Michel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Valve Dis"
                        "fecha" => "1993"
                        "volumen" => "2"
                        "paginaInicial" => "430"
                        "paginaFinal" => "439"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8269146"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous coronary intervention in patients with severe aortic stenosis&#58; implications for transcatheter aortic valve replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;S&#46; Goel"
                            1 => "S&#46; Agarwal"
                            2 => "E&#46;M&#46; Tuzcu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.111.039180"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2012"
                        "volumen" => "125"
                        "paginaInicial" => "1005"
                        "paginaFinal" => "1013"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22282327"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Balloon aortic valvuloplasty in the era of transcatheter aortic valve replacement&#58; acute and long-term outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Eltchaninoff"
                            1 => "E&#46; Durand"
                            2 => "B&#46; Borz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2013.10.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2014"
                        "volumen" => "167"
                        "paginaInicial" => "235"
                        "paginaFinal" => "240"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24439985"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of outcomes in high-risk patients &#62;70 years of age with aortic valvuloplasty and percutaneous coronary intervention versus aortic valvuloplasty alone"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46;R&#46; Pedersen"
                            1 => "P&#46;J&#46; Klaassen"
                            2 => "C&#46;W&#46; Pedersen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2007.12.033"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2008"
                        "volumen" => "101"
                        "paginaInicial" => "1309"
                        "paginaFinal" => "1314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18435963"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Concomitant percutaneous coronary intervention and transcatheter aortic valve replacement&#58; safe and feasible replacement alternative approaches in high-risk patients with severe aortic stenosis and coronary artery disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46;F&#46; Salhab"
                            1 => "A&#46;H&#46; Al Kindi"
                            2 => "J&#46;H&#46; Lane"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jocs.12176"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Surg"
                        "fecha" => "2013"
                        "volumen" => "28"
                        "paginaInicial" => "481"
                        "paginaFinal" => "483"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23869423"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Balloon valvuloplasty and rotational atherectomy stenting in a 92-year-old patient with severe aortic stenosis and unprotected&#44; critical left main disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;N&#46; Doshi"
                            1 => "W&#46; Sherman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2003.11.058"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2005"
                        "volumen" => "99"
                        "paginaInicial" => "477"
                        "paginaFinal" => "478"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15771934"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Feasibility and efficacy of the 2&#46;5 L and 3&#46;8 L impella percutaneous left ventricular support device during high-risk&#44; percutaneous coronary intervention in patients with severe aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Spiro"
                            1 => "V&#46; Venugopal"
                            2 => "Y&#46; Raja"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ccd.25355"
                      "Revista" => array:6 [
                        "tituloSerie" => "Catheter Cardiovasc Interv"
                        "fecha" => "2014"
                        "volumen" => "85"
                        "paginaInicial" => "981"
                        "paginaFinal" => "989"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24408882"
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Revista Portuguesa de Cardiologia (English edition)
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