Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry.
J Am Coll Cardiol
; 62(17): 1552-62, 2013 Oct 22.
Article
em En
| MEDLINE
| ID: mdl-23954337
ABSTRACT
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 11 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 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 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.Palavras-chave
CABG; CT; IQR; LCA; PCI; RCA; SOV; TAVI; TIMI; Thrombolysis In Myocardial Infarction; computed tomography; coronary artery bypass graft; coronary obstruction; coronary occlusion; interquartile range; left coronary artery; logEuroSCORE; logistic European System for Cardiac Operative Risk Evaluation score; percutaneous aortic valve replacement; percutaneous coronary intervention; right coronary artery; sinus of Valsalva; transcatheter aortic valve implantation
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Cateterismo Cardíaco
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Sistema de Registros
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Implante de Prótese de Valva Cardíaca
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Oclusão Coronária
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Cardiopatias Congênitas
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Doenças das Valvas Cardíacas
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article