Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement.
J Am Coll Cardiol
; 71(14): 1513-1524, 2018 04 10.
Article
in En
| MEDLINE
| ID: mdl-29622157
ABSTRACT
BACKGROUND:
Delayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR).OBJECTIVES:
The aim of this study was to describe the incidence and pathophysiological features of DCO after TAVR, obtained from a large international multicenter registry.METHODS:
Data were retrospectively collected from an international multicenter registry consisting of 18 centers between November 2005 and December 2016.RESULTS:
During the study period, 38 DCO (incidence 0.22%) cases were identified from a total of 17,092 TAVR procedures. DCO occurred more commonly after valve-in-valve procedures (0.89% vs. 0.18%; p < 0.001) and if self-expandable valves were used during the index procedure (0.36% vs. 0.11% balloon expandable; p < 0.01). DCO was most likely to occur ≤24 h after the TAVR procedure (47.4%; n = 18); 6 (15.8%) cases occurred between 24 h and ≤7 days, with the remaining 14 (36.8%) at ≥60 days. The most frequent presentation was cardiac arrest (31.6%; n = 12), followed by ST-segment elevation myocardial infarction (23.7%; n = 9). The left coronary artery was obstructed in most cases (92.1%; n = 35). Percutaneous coronary intervention was attempted in the majority of cases (74.3% left main; 60% right coronary), and stent implantation was successful in 68.8%. The overall in-hospital death rate was 50% (n = 19), and was higher if DCO occurred ≤7 days from the index procedure (62.5% vs. 28.6%; p = 0.09).CONCLUSIONS:
DCO following TAVR is a rare phenomenon that is associated with a high in-hospital mortality rate. Clinicians should be aware that coronary obstruction can occur after the original TAVR procedure and have a low threshold for performing coronary angiography when clinically suspected.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Postoperative Complications
/
Registries
/
Coronary Occlusion
/
Transcatheter Aortic Valve Replacement
Type of study:
Diagnostic_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged80
/
Female
/
Humans
/
Male
Country/Region as subject:
America do norte
/
Asia
/
Europa
Language:
En
Journal:
J Am Coll Cardiol
Year:
2018
Document type:
Article
Affiliation country:
United kingdom