Federico Mercanti1, Liesbeth Rosseel1, Antoinette Neylon1, Rodrigo Bagur2, Jan-Malte Sinning3, Georg Nickenig3, Eberhard Grube3, David Hildick-Smith4, Davide Tavano5, Alexander Wolf6, Giuseppe Colonna7, Azeem Latib8, Satoru Mitomo8, Anna Sonia Petronio9, Marco Angelillis9, Didier Tchétché10, Chiara De Biase10, Marianna Adamo11, Mohammed Nejjari12, Franck Digne12, Ulrich Schäfer13, Nicolas Amabile14, Guy Achkouty14, Raj R Makkar15, Sung-Han Yoon15, Ariel Finkelstein16, Danny Dvir17, Tara Jones17, Bernard Chevalier18, Thierry Lefevre18, Nicolo Piazza19, Darren Mylotte20. 1. University Hospital and SAOLTA University Health Care Group, Galway, Ireland. 2. Division of Cardiology, London Health Sciences Centre, School of Medicine & Dentistry, Western University, London, Ontario, Canada. 3. Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany. 4. Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom. 5. IRCCS Multimedica, Sesto San Giovanni, Milan, Italy. 6. Department of Interventional Cardiology, Elisabeth Hospital Essen, Essen, Germany. 7. Department of Cardiology, Vito Fazzi Hospital, Lecce, Italy. 8. Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy. 9. Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. 10. Clinique Pasteur, Groupe Cardiovasculaire Interventionel, Toulouse, France. 11. Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy. 12. Hemodynamic Department, Centre Cardiologique du Nord, Saint Denis, France. 13. Department of General and Interventional Cardiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 14. Department of Cardiology, Institut Mutualiste Montsouris, Paris, France. 15. Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. 16. Tel Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel. 17. Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington. 18. Institut Cardiovasculaire de Paris, Massy, France. 19. McGill University Health Centre, Montreal, Quebec, Canada. 20. University Hospital and SAOLTA University Health Care Group, Galway, Ireland; National University of Ireland, Galway, Ireland. Electronic address: darrenmylotte@gmail.com.
Abstract
OBJECTIVES: The aim of this study was to determine the safety and efficacy of chimney stenting, a bailout technique to treat coronary artery occlusion (CAO). BACKGROUND: CAO during transcatheter aortic valve replacement (TAVR) is a rare but often fatal complication. METHODS: In the international Chimney Registry, patient and procedural characteristics and data on outcomes are retrospectively collected from patients who underwent chimney stenting during TAVR. RESULTS: To date, 16 centers have contributed 60 cases among 12,800 TAVR procedures (0.5%). Chimney stenting was performed for 2 reasons: 1) due to the development of an established CAO (n = 25 [41.6%]); or 2) due to an impending CAO (n = 35 [58.3%]). The majority of cases (92.9%) had 1 or more classical risk factors for CAO. Upfront coronary protection was performed in 44 patients (73.3%). Procedural and in-hospital mortality occurred in 1 and 2 patients, respectively. Myocardial infarction (52.0% vs. 0.0%; p < 0.01), cardiogenic shock (52.0% vs. 2.9%; p < 0.01), and resuscitation (44.0% vs. 2.9%; p < 0.01) all occurred more frequently in patients with established CAO compared with those with impending CAO. The absence of upfront coronary protection was the sole independent risk factor for the combined endpoint of death, cardiogenic shock, or myocardial infarction. During a median follow-up time of 612 days (interquartile range: 405 to 842 days), 2 cases of stent failure were reported (1 in-stent restenosis, 1 possible late stent thrombosis) after 157 and 374 days. CONCLUSIONS: Chimney stenting appears to be an acceptable bailout technique for CAO, with higher event rates among those with established CAO and among those without upfront coronary protection.
OBJECTIVES: The aim of this study was to determine the safety and efficacy of chimney stenting, a bailout technique to treat coronary artery occlusion (CAO). BACKGROUND:CAO during transcatheter aortic valve replacement (TAVR) is a rare but often fatal complication. METHODS: In the international Chimney Registry, patient and procedural characteristics and data on outcomes are retrospectively collected from patients who underwent chimney stenting during TAVR. RESULTS: To date, 16 centers have contributed 60 cases among 12,800 TAVR procedures (0.5%). Chimney stenting was performed for 2 reasons: 1) due to the development of an established CAO (n = 25 [41.6%]); or 2) due to an impending CAO (n = 35 [58.3%]). The majority of cases (92.9%) had 1 or more classical risk factors for CAO. Upfront coronary protection was performed in 44 patients (73.3%). Procedural and in-hospital mortality occurred in 1 and 2 patients, respectively. Myocardial infarction (52.0% vs. 0.0%; p < 0.01), cardiogenic shock (52.0% vs. 2.9%; p < 0.01), and resuscitation (44.0% vs. 2.9%; p < 0.01) all occurred more frequently in patients with established CAO compared with those with impending CAO. The absence of upfront coronary protection was the sole independent risk factor for the combined endpoint of death, cardiogenic shock, or myocardial infarction. During a median follow-up time of 612 days (interquartile range: 405 to 842 days), 2 cases of stent failure were reported (1 in-stent restenosis, 1 possible late stent thrombosis) after 157 and 374 days. CONCLUSIONS: Chimney stenting appears to be an acceptable bailout technique for CAO, with higher event rates among those with established CAO and among those without upfront coronary protection.
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
Authors: Dirk Westermann; Sebastian Ludwig; Daniel Kalbacher; Clemens Spink; Matthias Linder; Oliver D Bhadra; Julius Nikorowitsch; Lara Waldschmidt; Till Demal; Lisa Voigtländer; Andreas Schaefer; Moritz Seiffert; Simon Pecha; Niklas Schofer; Adam B Greenbaum; Hermann Reichenspurner; Stefan Blankenberg; Lenard Conradi; Johannes Schirmer Journal: Clin Res Cardiol Date: 2021-06-22 Impact factor: 5.460