Author + information
- Henrique Barbosa Ribeiro,
- Luis Nombela–Franco,
- Marina Urena,
- Michael Mok,
- Sergio Pasian,
- Daniel Doyle,
- Robert De Larochellière,
- Melanie Cote,
- Louis Laflamme,
- Hugo De Larochelliere,
- Eric Dumont and
- Josep Rodes–Cabau
Very few data exist on coronary obstruction following transcatheter aortic valve implantation (TAVI). The objective of this study was to evaluate, through a systematic review of the literature, the main baseline characteristics, management and clinical outcomes of patients suffering coronary obstruction following TAVI.
Studies published between 2002 and 2012, with regards to coronary obstruction as a complication of TAVI, were identified using a systematic electronic search. Only the studies reporting data on the main baseline and procedural characteristics, management of the complication, and clinical outcomes were analyzed.
A total of 16 publications describing 24 patients who had experienced coronary obstruction related to a TAVI were identified. Most (83%) patients were women, with a mean age of 83±7 years, and a mean logistic EuroSCORE of 25.1 ± 12.0%. Most patients (88%) had received a balloon–expandable valve, and coronary obstruction occurred more frequently at the level of the left coronary artery ostium (LCA; 88%), that presented a mean height of 10.3±1.6 mm. Most (88%) patients presented with persistent severe hypotension and 54.2% exhibited ST–segment changes, usually occurring immediately after valve implantation. Percutaneous coronary intervention (PCI) was attempted in 23 cases (95.8%) and was successful in all but 2 patients (91.3%). Stent recoil requiring a second stent, mechanical hemodynamic support and conversion to open–heart surgery were required in 3, 6, and 2 patients, respectively. At 30–day follow–up, there were no cases of stent thrombosis or repeat revascularization, and the mortality rate was of 8.3% (0% among those patients who had had successful PCI).
Coronary obstruction following TAVI occurred more frequently in women, and in patients receiving a balloon–expandable valve, and the LCA was the most commonly involve artery. PCI was a feasible and successful treatment in most cases, but complication rates remained important. Continuous efforts should be made to identify the factors associated with this life threatening complication in order to implement the appropriate measures for its prevention.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2114–244
- 2013 American College of Cardiology Foundation