AIMS: Coronary protection with guidewires and an undeployed coronary balloon or stent positioned in the coronary artery is a pre-emptive technique to manage coronary obstruction during transcatheter aortic valve implantation (TAVI). We investigated the feasibility and safety of left main (LM) protection during TAVI. METHODS AND RESULTS: Twenty-five out of 623 patients who underwent TAVI at our institute were deemed to be at increased risk of LM compromise mainly due to a low LM ostium height, significant LM disease or a previous bioprosthetic valve. A pre-emptive LM protection technique was therefore used in these cases. Five patients (20%) had pre-TAVI significant non-revascularised LM stenosis, and four patients (16%) had a prior LM ostial stent without pre-TAVI in-stent restenosis. Twelve patients had extremely low LM height (mean height 6.7±2.4 mm; range 1.1-8.9 mm). Seven patients (25%) had valve-in-valve (VIV) procedures. LM compromise occurred in five out of 25 cases; all were treated successfully with emergency LM stenting. Nine patients underwent successful planned LM procedures following TAVI. CONCLUSIONS: The LM protection technique should be considered in patients deemed to be at increased risk of LM compromise. This was found to be helpful in the prompt diagnosis and treatment of LM compromise following TAVI.
AIMS: Coronary protection with guidewires and an undeployed coronary balloon or stent positioned in the coronary artery is a pre-emptive technique to manage coronary obstruction during transcatheter aortic valve implantation (TAVI). We investigated the feasibility and safety of left main (LM) protection during TAVI. METHODS AND RESULTS: Twenty-five out of 623 patients who underwent TAVI at our institute were deemed to be at increased risk of LM compromise mainly due to a low LM ostium height, significant LM disease or a previous bioprosthetic valve. A pre-emptive LM protection technique was therefore used in these cases. Five patients (20%) had pre-TAVI significant non-revascularised LM stenosis, and four patients (16%) had a prior LM ostial stent without pre-TAVI in-stent restenosis. Twelve patients had extremely low LM height (mean height 6.7±2.4 mm; range 1.1-8.9 mm). Seven patients (25%) had valve-in-valve (VIV) procedures. LM compromise occurred in five out of 25 cases; all were treated successfully with emergency LM stenting. Nine patients underwent successful planned LM procedures following TAVI. CONCLUSIONS: The LM protection technique should be considered in patients deemed to be at increased risk of LM compromise. This was found to be helpful in the prompt diagnosis and treatment of LM compromise following TAVI.
Authors: Jaffar M Khan; Danny Dvir; Adam B Greenbaum; Vasilis C Babaliaros; Toby Rogers; Gabriel Aldea; Mark Reisman; G Burkhard Mackensen; Marvin H K Eng; Gaetano Paone; Dee Dee Wang; Robert A Guyton; Chandan M Devireddy; William H Schenke; Robert J Lederman Journal: JACC Cardiovasc Interv Date: 2018-04-09 Impact factor: 11.195
Authors: Robert J Lederman; Vasilis C Babaliaros; Toby Rogers; Jaffar M Khan; Norihiko Kamioka; Danny Dvir; Adam B Greenbaum Journal: JACC Cardiovasc Interv Date: 2019-07-08 Impact factor: 11.195
Authors: Jaffar M Khan; Adam B Greenbaum; Vasilis C Babaliaros; Toby Rogers; Marvin H Eng; Gaetano Paone; Bradley G Leshnower; Mark Reisman; Lowell Satler; Ron Waksman; Marcus Y Chen; Annette M Stine; Xin Tian; Danny Dvir; Robert J Lederman Journal: JACC Cardiovasc Interv Date: 2019-06-12 Impact factor: 11.195
Authors: Iuliana Coti; Udo Maierhofer; Claus Rath; Paul Werner; Christian Loewe; Alfred Kocher; Guenther Laufer; Martin Andreas Journal: Interact Cardiovasc Thorac Surg Date: 2021-01-22