Richard J Jabbour1, Akihito Tanaka2, Ariel Finkelstein3, Michael Mack4, Corrado Tamburino5, Nicolas Van Mieghem6, Ole de Backer7, Luca Testa8, Pamela Gatto9, Paola Purita10, Zouhair Rahhab6, Verena Veulemans11, Anja Stundl12, Marco Barbanti5, Roberto Nerla13, Jan Malte Sinning12, Danny Dvir14, Giuseppe Tarantini10, Molly Szerlip4, Werner Scholtz15, Smita Scholtz15, Didier Tchetche9, Fausto Castriota13, Christian Butter16, Lars Søndergaard7, Mohamed Abdel-Wahab17, Horst Sievert18, Ottavio Alfieri19, John Webb14, Josep Rodés-Cabau20, Antonio Colombo2, Azeem Latib21. 1. Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Imperial College London, London, United Kingdom. 2. Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. 3. Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel. 4. The Heart Hospital Baylor Plano, Plano, Texas. 5. Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy. 6. Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. 7. Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 8. Department of Cardiology, IRCCS Pol. San Donato, Milan, Italy. 9. Clinique Pasteur, Toulouse, France. 10. Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy. 11. Department of Cardiology, Pulmonology, and Angiology, University Hospital, Düsseldorf, Germany. 12. Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany. 13. Interventional Cardiology Unit, GVM Maria Cecilia Hospital, Cotignola, Italy. 14. Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 15. Department of Cardiology, Heart and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Oeynhausen, Germany. 16. Department of Cardiology, Heart Center Brandenburg, Bernau bei Berlin, Germany. 17. Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany. 18. CardioVascular Center Frankfurt CVC, Sankt Katharinen Krankenhaus, Frankfurt, Germany. 19. Cardiothoracic Unit, San Raffaele Scientific Institute, Milan, Italy. 20. Quebec Heart and Lung Institute, Quebec City, Quebec, Canada. 21. Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. Electronic address: alatib@gmail.com.
Abstract
BACKGROUND: Delayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR). OBJECTIVES: The aim of this study was to describe the incidence and pathophysiological features of DCO after TAVR, obtained from a large international multicenter registry. METHODS: Data were retrospectively collected from an international multicenter registry consisting of 18 centers between November 2005 and December 2016. RESULTS: During the study period, 38 DCO (incidence 0.22%) cases were identified from a total of 17,092 TAVR procedures. DCO occurred more commonly after valve-in-valve procedures (0.89% vs. 0.18%; p < 0.001) and if self-expandable valves were used during the index procedure (0.36% vs. 0.11% balloon expandable; p < 0.01). DCO was most likely to occur ≤24 h after the TAVR procedure (47.4%; n = 18); 6 (15.8%) cases occurred between 24 h and ≤7 days, with the remaining 14 (36.8%) at ≥60 days. The most frequent presentation was cardiac arrest (31.6%; n = 12), followed by ST-segment elevation myocardial infarction (23.7%; n = 9). The left coronary artery was obstructed in most cases (92.1%; n = 35). Percutaneous coronary intervention was attempted in the majority of cases (74.3% left main; 60% right coronary), and stent implantation was successful in 68.8%. The overall in-hospital death rate was 50% (n = 19), and was higher if DCO occurred ≤7 days from the index procedure (62.5% vs. 28.6%; p = 0.09). CONCLUSIONS: DCO following TAVR is a rare phenomenon that is associated with a high in-hospital mortality rate. Clinicians should be aware that coronary obstruction can occur after the original TAVR procedure and have a low threshold for performing coronary angiography when clinically suspected.
BACKGROUND: Delayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR). OBJECTIVES: The aim of this study was to describe the incidence and pathophysiological features of DCO after TAVR, obtained from a large international multicenter registry. METHODS: Data were retrospectively collected from an international multicenter registry consisting of 18 centers between November 2005 and December 2016. RESULTS: During the study period, 38 DCO (incidence 0.22%) cases were identified from a total of 17,092 TAVR procedures. DCO occurred more commonly after valve-in-valve procedures (0.89% vs. 0.18%; p < 0.001) and if self-expandable valves were used during the index procedure (0.36% vs. 0.11% balloon expandable; p < 0.01). DCO was most likely to occur ≤24 h after the TAVR procedure (47.4%; n = 18); 6 (15.8%) cases occurred between 24 h and ≤7 days, with the remaining 14 (36.8%) at ≥60 days. The most frequent presentation was cardiac arrest (31.6%; n = 12), followed by ST-segment elevation myocardial infarction (23.7%; n = 9). The left coronary artery was obstructed in most cases (92.1%; n = 35). Percutaneous coronary intervention was attempted in the majority of cases (74.3% left main; 60% right coronary), and stent implantation was successful in 68.8%. The overall in-hospital death rate was 50% (n = 19), and was higher if DCO occurred ≤7 days from the index procedure (62.5% vs. 28.6%; p = 0.09). CONCLUSIONS:DCO following TAVR is a rare phenomenon that is associated with a high in-hospital mortality rate. Clinicians should be aware that coronary obstruction can occur after the original TAVR procedure and have a low threshold for performing coronary angiography when clinically suspected.
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
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Authors: Jaffar M Khan; Vasilis C Babaliaros; Adam B Greenbaum; Christian Spies; David Daniels; Jeremiah P Depta; J Bradley Oldemeyer; Brian Whisenant; James M McCabe; Kamran I Muhammad; Isaac George; Paul Mahoney; Jonas Lanz; Roger J Laham; Pinak B Shah; Adnan Chhatriwalla; Shahram Yazdani; George Hanzel; Ashish Pershad; Robert A Leonardi; Ramzi Khalil; Gilbert H L Tang; Howard C Herrmann; Shikhar Agarwal; Peter S Fail; Ming Zhang; Andrei Pop; John Lisko; Emily Perdoncin; Rachel L Koch; Itsik Ben-Dor; Lowell F Satler; Cheng Zhang; Jeffrey E Cohen; Robert J Lederman; Ron Waksman; Toby Rogers Journal: JACC Cardiovasc Interv Date: 2021-03-06 Impact factor: 11.195
Authors: Jaffar M Khan; Adam B Greenbaum; Vasilis C Babaliaros; Danny Dvir; Mark Reisman; James M McCabe; Lowell Satler; Ron Waksman; Marvin H Eng; Gaetano Paone; Marcus Y Chen; Christopher G Bruce; Annette M Stine; Xin Tian; Toby Rogers; Robert J Lederman Journal: Circ Cardiovasc Interv Date: 2021-05-18 Impact factor: 6.546