Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry.

MedStar author(s):
Citation: Journal of the American College of Cardiology. 62(17):1552-62, 2013 Oct 22.PMID: 23954337Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Case Reports | Journal Article | Multicenter Study | Research Support, Non-U.S. Gov'tSubject headings: *Cardiac Catheterization/ae [Adverse Effects] | *Coronary Occlusion/di [Diagnosis] | *Heart Defects, Congenital/su [Surgery] | *Heart Valve Diseases/su [Surgery] | *Heart Valve Prosthesis Implantation/ae [Adverse Effects] | *Postoperative Complications/di [Diagnosis] | *Registries | Aged | Aged, 80 and over | Aortic Valve/su [Surgery] | Cohort Studies | Coronary Occlusion/mo [Mortality] | Coronary Occlusion/th [Therapy] | Disease Management | Female | Heart Defects, Congenital/mo [Mortality] | Heart Valve Diseases/mo [Mortality] | Humans | Male | Postoperative Complications/mo [Mortality] | Postoperative Complications/th [Therapy] | Predictive Value of Tests | Retrospective Studies | Treatment OutcomeLocal holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0735-1097
Name of journal: Journal of the American College of CardiologyAbstract: BACKGROUND: Very little data exist on CO following TAVI.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. Copyright 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.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).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).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 in patients 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 130224s (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.All authors: Amat-Santos IJ, Babaliaros V, Barbanti M, Canovas SJ, Chakravarty T, Cheema AN, Chiam PT, Cohen MG, Cura F, Dager AE, de Brito FS Jr, de Jaegere PP, del Valle R, Dumont E, Jilaihawi H, Kapadia SR, Kodali S, Larose E, Leipsic J, Leon MB, Lerakis S, Makkar RR, Manoharan G, Moreno R, Nombela-Franco L, Paradis JM, Pasian SG, Perin MA, Pichard AD, Pradas G, Radhakrishnan S, Ribeiro HB, Rodes-Cabau J, Ruel M, Salgado-Fernandez J, Sarmento-Leite R, Tamburino C, Toeg HD, Tuzcu EM, Urena M, Velianou JL, Webb JG, Zajarias ADigital Object Identifier: Date added to catalog: 2014-02-24
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 23954337

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: Very little data exist on CO following TAVI.

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. Copyright 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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).

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).

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 in patients 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 130224s (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.

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