Coronary Protection to Prevent Coronary Obstruction During TAVR: A Multicenter International Registry.

Aged Aged, 80 and over Aortic Valve / diagnostic imaging Computed Tomography Angiography Coronary Angiography Coronary Stenosis / diagnostic imaging Coronary Vessels / diagnostic imaging Female Heart Valve Prosthesis Humans Male Percutaneous Coronary Intervention / adverse effects Prosthesis Design Registries Retrospective Studies Risk Factors Stents Time Factors Transcatheter Aortic Valve Replacement / adverse effects Treatment Outcome

coronary obstruction stent thrombosis transcatheter aortic valve replacement

Journal

JACC. Cardiovascular interventions

ISSN: 1876-7605

Titre abrégé: JACC Cardiovasc Interv

Pays: United States

ID NLM: 101467004

Informations de publication

Date de publication:
23 03 2020

Historique:

received: 02 10 2019

revised: 12 11 2019

accepted: 19 11 2019

pubmed: 18 2 2020

medline: 21 10 2020

entrez: 17 2 2020

Statut: ppublish

Résumé

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). Coronary obstruction following TAVR is a life-threatening complication with high procedural and short-term mortality. Data were collected retrospectively from a multicenter international registry between April 2011 and February 2019. 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). 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.

Sections du résumé

OBJECTIVES

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.

Identifiants

DOI: 10.1016/j.jcin.2019.11.024 PMID: 32061608

pubmed: 32061608

pii: S1936-8798(19)32461-6

doi: 10.1016/j.jcin.2019.11.024

pii:

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

739-747

Commentaires et corrections

Type : CommentIn