Chimney Stenting for Coronary Occlusion During TAVR: Insights From the Chimney Registry.

Aged Aged, 80 and over Aortic Valve / diagnostic imaging Coronary Occlusion / diagnostic imaging Coronary Restenosis / etiology Coronary Thrombosis / etiology Europe Female Heart Valve Prosthesis Hospital Mortality Humans Male Middle East North America Percutaneous Coronary Intervention / adverse effects Prosthesis Design Registries Retrospective Studies Risk Factors Stents Time Factors Transcatheter Aortic Valve Replacement / adverse effects Treatment Outcome

chimney stenting coronary artery obstruction coronary protection myocardial infarction 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: 04 11 2019

revised: 21 01 2020

accepted: 23 01 2020

entrez: 21 3 2020

pubmed: 21 3 2020

medline: 21 10 2020

Statut: ppublish

Résumé

The aim of this study was to determine the safety and efficacy of chimney stenting, a bailout technique to treat coronary artery occlusion (CAO). CAO during transcatheter aortic valve replacement (TAVR) is a rare but often fatal complication. In the international Chimney Registry, patient and procedural characteristics and data on outcomes are retrospectively collected from patients who underwent chimney stenting during TAVR. 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. 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.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.jcin.2020.01.227 PMID: 32192695

pubmed: 32192695

pii: S1936-8798(20)30408-8

doi: 10.1016/j.jcin.2020.01.227

pii:

doi:

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

751-761

Commentaires et corrections

Type : CommentIn