Author/Authors :
Ribeiro، نويسنده , , Henrique B. and Webb، نويسنده , , John G. and Makkar، نويسنده , , Raj R. and Cohen، نويسنده , , Mauricio G. and Kapadia، نويسنده , , Samir R. and Kodali، نويسنده , , Susheel and Tamburino، نويسنده , , Corrado and Barbanti، نويسنده , , Marco and Chakravarty، نويسنده , , Tarun and Jilaihawi، نويسنده , , Hasan and Paradis، نويسنده , , Jean-Michel and de Brito Jr.، نويسنده , , Fabio S. and Cلnovas، نويسنده , , Sergio J. and Cheema، نويسنده , , Asim N. and de Jaegere، نويسنده , , Peter P. and del Valle، نويسنده , , Raquel and Chiam، نويسنده , , Paul T.L. and Moreno، نويسنده , , Raْl and Pradas، نويسنده , , Gonzalo and Ruel، نويسنده , , Marc and Salgado-Fernلndez، نويسنده , , Jorge and Sarmento-Leite، نويسنده , , Rogerio and Toeg، نويسنده , , Hadi D. and Velianou، نويسنده , , James L. and Zajarias، نويسنده , , Alan and Babaliaros، نويسنده , , Vasilis and Cura، نويسنده , , Fernando and Dager، نويسنده , , Antonio E. and Manoharan، نويسنده , , Ganesh and Lerakis، نويسنده , , Stamatios and Pichard، نويسنده , , Augusto D. and Radhakrishnan، نويسنده , , Sam and Perin، نويسنده , , Marco Antonio and Dumont، نويسنده , , Eric and Larose، نويسنده , , Eric and Pasian، نويسنده , , Sergio G. and Nombela-Franco، نويسنده , , Luis and Urena، نويسنده , , Marina and Tuzcu، نويسنده , , E. Murat and Leon، نويسنده , , Martin B. and Amat-Santos، نويسنده , , Ignacio J. and Leipsic، نويسنده , , Jonathon and Rodés-Cabau، نويسنده , , Josep، نويسنده ,
Abstract :
Objectives
tudy sought to evaluate the main baseline and procedural characteristics, management, and clinical outcomes of patients from a large cohort of patients undergoing transcatheter aortic valve implantation (TAVI) who suffered coronary obstruction (CO).
ound
ittle data exist on CO following TAVI.
s
ulticenter registry included 44 patients who suffered symptomatic CO following TAVI of 6,688 patients (0.66%). Pre-TAVI computed tomography data was available in 28 CO patients and in a control group of 345 patients (comparisons were performed including all patients and a cohort matched 1:1 by age, sex, previous coronary artery bypass graft, transcatheter valve type, and size).
s
ne and procedural variables associated with CO were older age (p < 0.001), female sex (p < 0.001), no previous coronary artery bypass graft (p = 0.043), the use of a balloon-expandable valve (p = 0.023), and previous surgical aortic bioprosthesis (p = 0.045). The left coronary artery was the most commonly involved (88.6%). The mean left coronary artery ostia height and sinus of Valsalva diameters were lower in patients with obstruction than in control subjects (10.6 ± 2.1 mm vs. 13.4 ± 2.1 mm, p < 0.001; 28.1 ± 3.8 mm vs. 31.9 ± 4.1 mm, p < 0.001). Differences between groups remained significant after the case-matched analysis (p < 0.001 for coronary height; p = 0.01 for sinus of Valsalva diameter). Most patients presented with persistent severe hypotension (68.2%) and electrocardiographic changes (56.8%). Percutaneous coronary intervention was attempted in 75% of the cases and was successful in 81.8%. Thirty-day mortality was 40.9%. After a median follow-up of 12 (2 to 18) months, the cumulative mortality rate was 45.5%, and there were no cases of stent thrombosis or reintervention.
sions
matic CO following TAVI was a rare but life-threatening complication that occurred more frequently in women, in patients receiving a balloon-expandable valve, and in those with a previous surgical bioprosthesis. Lower-lying coronary ostium and shallow sinus of Valsalva were associated anatomic factors, and despite successful treatment, acute and late mortality remained very high, highlighting the importance of anticipating and preventing the occurrence of this complication.
