Mini-Focus on TAVI
Coronary Obstruction Following Transcatheter Aortic Valve Implantation: A Systematic Review

https://doi.org/10.1016/j.jcin.2012.11.014Get rights and content
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Objectives

This study sought to evaluate, through a systematic review of the published data, the main baseline characteristics, management, and clinical outcomes of patients suffering coronary obstruction as a complication of transcatheter aortic valve implantation (TAVI).

Background

Very few data exist on coronary obstruction after TAVI.

Methods

Studies published between 2002 and 2012, with regard to coronary obstruction as a complication of TAVI, were identified with 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.

Results

A total of 18 publications describing 24 patients were identified. Most (83%) patients were women, with a mean age of 83 ± 7 years and a mean logistic European System for Cardiac Operative Risk Evaluation score of 25.1 ± 12.0%. Mean left coronary artery (LCA) ostium height and aortic root width were 10.3 ± 1.6 mm and 27.8 ± 2.8 mm, respectively. Most patients (88%) had received a balloon-expandable valve, and coronary obstruction occurred more frequently in the LCA (88%). Percutaneous coronary intervention was attempted in 23 cases (95.8%) and was successful in all but 2 patients (91.3%). At 30-day follow-up, there were no cases of stent thrombosis or repeat revascularization, and the mortality rate was 8.3%.

Conclusions

Reported cases of coronary obstruction after TAVI occurred more frequently in women, in patients receiving a balloon-expandable valve, and the LCA was the most commonly involved artery. Percutaneous coronary intervention was a feasible and successful treatment in most cases. Continuous efforts should be made to identify the factors associated with this life-threatening complication to implement the appropriate measures for its prevention.

Key Words

aortic stenosis
coronary obstruction
coronary occlusion
coronary stenosis
transcatheter aortic valve replacement
transcatheter heart valve

Abbreviations and Acronyms

CABG
coronary artery bypass graft
CAD
coronary artery disease
CT
computed tomography
LCA
left coronary artery
PCI
percutaneous coronary intervention
TAVI
transcatheter aortic valve implantation

Cited by (0)

Dr. DeLarochellière is a consultant for St. Jude Medical. Dr. Dumont is a consultant for Edwards Lifesciences. Dr. Rodés-Cabau is a consultant for Edwards Lifesciences and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.