Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement

Richard J. Jabbour, Akihito Tanaka, Ariel Finkelstein, Michael Mack, Corrado Tamburino, Nicolas Van Mieghem, Ole de Backer, Luca Testa, Pamela Gatto, Paola Purita, Zouhair Rahhab, Verena Veulemans, Anja Stundl, Marco Barbanti, Roberto Nerla, Jan Malte Sinning, Danny Dvir, Giuseppe Tarantini, Molly Szerlip, Werner ScholtzSmita Scholtz, Didier Tchetche, Fausto Castriota, Christian Butter, Lars Søndergaard, Mohamed Abdel-Wahab, Horst Sievert, Ottavio Alfieri, John Webb, Josep Rodés-Cabau, Antonio Colombo, Azeem Latib

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)1513-1524
Number of pages12
JournalJournal of the American College of Cardiology
Volume71
Issue number14
DOIs
Publication statusPublished - Apr 10 2018

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Keywords

  • coronary obstruction
  • TAVI
  • TAVR
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Jabbour, R. J., Tanaka, A., Finkelstein, A., Mack, M., Tamburino, C., Van Mieghem, N., de Backer, O., Testa, L., Gatto, P., Purita, P., Rahhab, Z., Veulemans, V., Stundl, A., Barbanti, M., Nerla, R., Sinning, J. M., Dvir, D., Tarantini, G., Szerlip, M., ... Latib, A. (2018). Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology, 71(14), 1513-1524. https://doi.org/10.1016/j.jacc.2018.01.066