Predictive Factors, Management, and Clinical Outcomes of Coronary Obstruction Following Transcatheter Aortic Valve Implantation Insights From a Large Multicenter Registry

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:62

Article

Ribeiro, Henrique B.¹  Webb, John G.^2,3  Makkar, Raj R.⁴  Cohen, Mauricio G.⁵  Kapadia, Samir R.⁶  Kodali, Susheel⁷  Tamburino, Corrado⁸  Barbanti, Marco^2,3,8  Chakravarty, Tarun⁴  Jilaihawi, Hasan⁴  Paradis, Jean-Michel⁷  de Brito, Fabio S., Jr.⁹  Canovas, Sergio J.¹⁰  Cheema, Asim N.¹¹  de Jaegere, Peter P.¹²  del Valle, Raquel¹³  Chiam, Paul T. L.¹⁴  Moreno, Raul¹⁵  Pradas, Gonzalo¹⁶  Ruel, Marc¹⁷  Salgado-Fernandez, Jorge¹⁸  Sarmento-Leite, Rogerio¹⁹  Toeg, Hadi D.¹⁷  Velianou, James L.²⁰  Zajarias, Alan²¹  Babaliaros, Vasilis²²  Cura, Fernando²³  Dager, Antonio E.²⁴  Manoharan, Ganesh²⁵  Lerakis, Stamatios²²  Pichard, Augusto D.²⁶  Radhakrishnan, Sam²⁷  Perin, Marco Antonio⁹  Dumont, Eric¹  Larose, Eric¹  Pasian, Sergio G.¹  Nombela-Franco, Luis¹  Urena, Marina¹  Tuzcu, E. Murat⁶  Leon, Martin B.⁷  Amat-Santos, Ignacio J.²⁸  Leipsic, Jonathon^2,3  Rodes-Cabau, Josep¹ 

[1] Univ Laval, Quebec Heart & Lung Inst, Dept Cardiol, Quebec City, PQ G1V 4G5, Canada

[2] Univ British Columbia, St Pauls Hosp, Dept Cardiol, Vancouver, BC V5Z 1M9, Canada

[3] Univ British Columbia, St Pauls Hosp, Dept Radiol, Vancouver, BC V5Z 1M9, Canada

[4] Cedars Sinai Med Ctr, Dept Cardiovasc Intervent Ctr & Cardiothorac Surg, Los Angeles, CA 90048 USA

[5] Univ Miami, Dept Med, Div Cardiovasc, Miami, FL USA

[6] Cleveland Clin, Miller Family Heart & Vasc Inst, Cleveland, OH 44106 USA

[7] Columbia Univ, Med Ctr, Ctr Intervent Vasc Therapy, NewYork Presbyterian Hosp, New York, NY USA

[8] Univ Catania, Ferrarotto Hosp, Div Cardiol, Catania, Italy

[9] Hosp Israelita Albert Einstein, Sao Paulo, Brazil

[10] Univ Gen Hosp Valencia, Dept Cardiac Surg, Valencia, Spain

[11] Univ Toronto, St Michaels Hosp, Div Cardiol, Toronto, ON, Canada

[12] Erasmus MC, Thoraxctr, Dept Cardiol, Rotterdam, Netherlands

[13] Asturias Univ Hosp, Dept Cardiol, Oviedo, Spain

[14] Natl Heart Ctr, Dept Cardiol, Singapore, Singapore

[15] Univ Hosp La Paz, Div Intervent Cardiol, Madrid, Spain

[16] Vigo Univ Hosp, Dept Cardiac Surg, Vigo, Spain

[17] Univ Ottawa, Inst Heart, Div Cardiac Surg, Ottawa, ON, Canada

[18] A Coruna Univ Hosp, Dept Cardiol, La Coruna, Spain

[19] Inst Cardiol Rio Grande Do Sul, Porto Alegre, RS, Brazil

[20] McMaster Univ, Dept Med, Hamilton Gen Hosp, Div Cardiol, Hamilton, ON, Canada

[21] Washington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA

[22] Emory Univ Hosp, Dept Med, Div Cardiol, Atlanta, GA 30322 USA

[23] Inst Cardiovasc Buenos Aires, Dept Intervent Cardiol, Buenos Aires, DF, Argentina

[24] Angiog Occidente SA, Dept Cardiol, Cali, Colombia

[25] Royal Victoria Hosp, Belfast Heart Ctr, Belfast BT12 6BA, Antrim, North Ireland

[26] MedStar Washington Hosp Ctr, Washington, DC USA

[27] Univ Toronto, Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada

[28] Hosp Clin Univ Valladolid, Inst Ciencias Corazon ICICOR, Valladolid, Spain

关键词: coronary obstruction;    coronary occlusion;    percutaneous aortic valve replacement;    percutaneous coronary intervention;    transcatheter aortic valve implantation;   

DOI  :  10.1016/j.jacc.2013.07.040

来源: Elsevier

【 摘 要 】

Objectives This study sought to evaluate the main baseline and procedural characteristics, management, and clinical outcomes of patients from a large cohort of patients undergoing transcatheter aortic valve implantation (TAVI) who suffered coronary obstruction (CO). Background Very little data exist on CO following TAVI. Methods This multicenter registry included 44 patients who suffered symptomatic CO following TAVI of 6,688 patients (0.66%). Pre-TAVI computed tomography data was available in 28 CO patients and in a control group of 345 patients (comparisons were performed including all patients and a cohort matched 1: 1 by age, sex, previous coronary artery bypass graft, transcatheter valve type, and size). Results Baseline and procedural variables associated with CO were older age (p<0.001), female sex (p<0.001), no previous coronary artery bypass graft (p = 0.043), the use of a balloon-expandable valve (p = 0.023), and previous surgical aortic bioprosthesis (p = 0.045). The left coronary artery was the most commonly involved (88.6%). The mean left coronary artery ostia height and sinus of Valsalva diameters were lower inpatients with obstruction than in control subjects (10.6 +/- 2.1 mm vs. 13.4 +/- 2.1 mm, p<0.001; 28.1 +/- 3.8 mm vs. 31.9 +/- 4.1 mm, p<0.001). Differences between groups remained significant after the case-matched analysis (p < 0.001 for coronary height; p = 0.01 for sinus of Valsalva diameter). Most patients presented with persistent severe hypotension (68.2%) and electrocardiographic changes (56.8%). Percutaneous coronary intervention was attempted in 75% of the cases and was successful in 81.8%. Thirty-day mortality was 40.9%. After a median follow-up of 12 (2 to 18) months, the cumulative mortality rate was 45.5%, and there were no cases of stent thrombosis or reintervention. Conclusions Symptomatic CO following TAVI was a rare but life-threatening complication that occurred more frequently in women, in patients receiving a balloon-expandable valve, and in those with a previous surgical bioprosthesis. Lower-lying coronary ostium and shallow sinus of Valsalva were associated anatomic factors, and despite successful treatment, acute and late mortality remained very high, highlighting the importance of anticipating and preventing the occurrence of this complication. (C) 2013 by the American College of Cardiology Foundation

【 授权许可】

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