Procedural and Mid-Term Outcomes of Coronary Protection During Transcatheter Aortic Valve Replacement in Patients at Risk of Coronary Occlusion: Insight From a Single-Centre Retrospective Analysis

Authors

Chak-Yu So, Henry Ford HealthFollow
Guson Kang, Henry Ford HealthFollow
Pedro A. Villablanca, Henry Ford HealthFollow
James C. Lee, Henry Ford HealthFollow
Tiberio M. Frisoli, Henry Ford HealthFollow
Janet F. Wyman, Henry Ford HealthFollow
Dee Dee Wang, Henry Ford HealthFollow
William W. O'Neill, Henry Ford HealthFollow
Marvin H. Eng, Henry Ford HealthFollow

Recommended Citation

So CY, Kang G, Villablanca PA, Lee JC, Frisoli TM, Wyman JF, Wang DD, O'Neill WW, and Eng MH. Procedural and Mid-Term Outcomes of Coronary Protection During Transcatheter Aortic Valve Replacement in Patients at Risk of Coronary Occlusion: Insight From a Single-Centre Retrospective Analysis. Cardiovasc Revasc Med 2021; 27:7-13.

Document Type

Article

Publication Date

6-1-2021

Publication Title

Cardiovasc Revasc Med

Abstract

BACKGROUND: Detailed procedural analysis and long-term data is limited for coronary protection (CP) during transcatheter aortic valve replacement (TAVR) for patients with high anatomical risk for coronary occlusion (CO). We aim to assess the procedural and mid-term outcomes of CP during TAVR.

METHODS: We retrospectively analyzed patients who underwent TAVR at Henry Ford Hospital, USA from January 2015 to August 2019 and identified those considered at risk of CO and underwent pre-emptive CP with or without subsequent "chimney" stenting (i.e. coronary stenting with intentional protrusion into the aorta). Procedural features, immediate and mid-term clinical outcomes were reviewed.

RESULTS: Twenty-five out of 1166 (2.1%) patients underwent TAVR with CP, including 10 (40%) valve-in-valve procedures. Twenty-eight coronary arteries (Left: n = 11, Right: n = 11; Left + Right: n = 3) were protected. Eleven coronaries (39.3%) were electively "chimney"-stented due to angiographic evidence of coronary impingement (63.6%), tactile resistance while withdrawing stent (27.3%) and electrocardiogram change (9.1%). Twenty-four patients (24/25, 96%) had successful TAVR without CO. Procedure-related complications included stent-balloon entrapment (n = 1), stent entrapment (n = 1) and occlusive distal stent edge dissection (n = 1). After a mean follow-up of 19.1 months, there was 1 cardiac death but no target vessel re-intervention or myocardial infarction.

CONCLUSIONS: Our study found that angiographic evidence of coronary impingement (63.6%) was the most common reason for stent deployment during TAVR with CP. The mid-term clinical outcome of CP with TAVR was favorable.

PubMed ID

32741589

Volume

27

First Page

7

Last Page

13