Coronary Protection to Prevent Coronary Obstruction During TAVR: A Multicenter International Registry: JACC: Cardiovascular Interventions

T. Palmerini, T. Chakravarty, F. Saia, A.G. Bruno, M.-L. Bacchi-Reggiani, C. Marrozzini, C. Patel, V. Patel, L. Testa, F. Bedogni, M. Ancona, M. Montorfano, A. Chieffo, P. Olivares, A.L. Bartorelli, A. Buscaglia, I. Porto, G. Nickenig, E. Grube, J.-M. SinningM. De Carlo, A.S. Petronio, M. Barbanti, C. Tamburino, A. Iadanza, F. Burzotta, C. Trani, C. Fraccaro, G. Tarantini, T.C. Aranzulla, M. De Benedictis, P. Pagnotta, G.G. Stefanini, M. Miura, M. Taramasso, J.-H. Kang, H.-S. Kim, P. Codner, R. Kornowski, F. Pelliccia, L. Vignali, N. Taglieri, G. Ghetti, A. Leone, N. Galiè, R. Makkar

Research output: Contribution to journalArticlepeer-review

Abstract

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
Original languageEnglish
Pages (from-to)739-747
Number of pages9
JournalJACC Cardiovasc. Interventions
Volume13
Issue number6
DOIs
Publication statusPublished - 2020

Keywords

  • coronary obstruction
  • stent thrombosis
  • transcatheter aortic valve replacement
  • aged
  • aortic valve
  • Article
  • cardiac patient
  • cerebrovascular accident
  • clinical outcome
  • coronary artery obstruction
  • coronary stenting
  • female
  • follow up
  • heart death
  • high risk patient
  • human
  • left coronary artery
  • major clinical study
  • male
  • multicenter study
  • priority journal
  • retrospective study
  • right coronary artery
  • survival rate
  • transcatheter aortic valve implantation
  • adverse event
  • clinical trial
  • computed tomographic angiography
  • coronary angiography
  • coronary blood vessel
  • devices
  • diagnostic imaging
  • heart valve prosthesis
  • mortality
  • pathophysiology
  • percutaneous coronary intervention
  • prosthesis design
  • register
  • risk factor
  • stent
  • surgery
  • time factor
  • treatment outcome
  • very elderly
  • Aged
  • Aged, 80 and over
  • Aortic Valve
  • Computed Tomography Angiography
  • Coronary Angiography
  • Coronary Stenosis
  • Coronary Vessels
  • Female
  • Heart Valve Prosthesis
  • Humans
  • Male
  • Percutaneous Coronary Intervention
  • Prosthesis Design
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Stents
  • Time Factors
  • Transcatheter Aortic Valve Replacement
  • Treatment Outcome

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