OBJECTIVES: The aim of this study was to investigate the safety and efficacy of coronary protection by preventive coronary wiring and stenting across the coronary ostia in patients at high risk for coronary obstruction after transcatheter aortic valve replacement (TAVR). BACKGROUND: Coronary obstruction following TAVR is a life-threatening complication with high procedural and short-term mortality. METHODS: Data were collected retrospectively from a multicenter international registry between April 2011 and February 2019. RESULTS: Among 236 patients undergoing coronary protection with preventive coronary wiring, 143 had eventually stents implanted across the coronary ostia after valve deployment. At 3-year follow-up, rates of cardiac death were 7.8% in patients receiving stents and 15.7% in those not receiving stents (adjusted hazard ratio: 0.42; 95% confidence interval: 0.14 to 1.28; p = 0.13). There were 2 definite stent thromboses (0.9%) in patients receiving stents, both occurring after TAVR in "valve-in-valve" procedures. In patients not receiving stents, there were 4 delayed coronary occlusions (DCOs) (4.3%), occurring from 5 min to 6 h after wire removal. Three cases occurred in valve-in-valve procedures and 1 in a native aortic valve procedure. Distance between the virtual transcatheter valve and the protected coronary ostia <4 mm was present in 75.0% of patients with DCO compared with 30.4% of patients without DCO (p = 0.19). CONCLUSIONS: In patients undergoing TAVR at high risk for coronary obstruction, preventive stent implantation across the coronary ostia is associated with good mid-term survival rates and low rates of stent thrombosis. Patients undergoing coronary protection with wire only have a considerable risk for DCO.
OBJECTIVES: The aim of this study was to investigate the safety and efficacy of coronary protection by preventive coronary wiring and stenting across the coronary ostia in patients at high risk for coronary obstruction after transcatheter aortic valve replacement (TAVR). BACKGROUND:Coronary obstruction following TAVR is a life-threatening complication with high procedural and short-term mortality. METHODS: Data were collected retrospectively from a multicenter international registry between April 2011 and February 2019. RESULTS: Among 236 patients undergoing coronary protection with preventive coronary wiring, 143 had eventually stents implanted across the coronary ostia after valve deployment. At 3-year follow-up, rates of cardiac death were 7.8% in patients receiving stents and 15.7% in those not receiving stents (adjusted hazard ratio: 0.42; 95% confidence interval: 0.14 to 1.28; p = 0.13). There were 2 definite stent thromboses (0.9%) in patients receiving stents, both occurring after TAVR in "valve-in-valve" procedures. In patients not receiving stents, there were 4 delayed coronary occlusions (DCOs) (4.3%), occurring from 5 min to 6 h after wire removal. Three cases occurred in valve-in-valve procedures and 1 in a native aortic valve procedure. Distance between the virtual transcatheter valve and the protected coronary ostia <4 mm was present in 75.0% of patients with DCO compared with 30.4% of patients without DCO (p = 0.19). CONCLUSIONS: In patients undergoing TAVR at high risk for coronary obstruction, preventive stent implantation across the coronary ostia is associated with good mid-term survival rates and low rates of stent thrombosis. Patients undergoing coronary protection with wire only have a considerable risk for DCO.
Authors: Gabriel Kanhouche; Felipe Reale Cividanes; Roney Orismar Sampaio; José Carlos Albuquerque da Silva; Rodrigo Daghlawi Machado; Marcelo Werneck; Tarso Augusto Duenhas Accorsi; Kevin Rafael De Paula Morales; Alexandre C Abizaid; Fabio Sandoli de Brito; Flavio Tarasoutchi; José Honório Palma; Henrique Barbosa Ribeiro Journal: J Cardiol Cases Date: 2021-07-19
Authors: Cristina Aurigemma; Francesco Burzotta; Rocco Vergallo; Piero Farina; Enrico Romagnoli; Stefano Cangemi; Francesco Bianchini; Marialisa Nesta; Piergiorgio Bruno; Domenico D'Amario; Antonio Maria Leone; Carlo Trani Journal: Front Cardiovasc Med Date: 2022-05-31
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