Procedural and mid-term outcomes of coronary protection: Insight from a single-center retrospective analysis
So CY, Kang G, Villablanca P, Lee J, Frisoli T, Wyman JF, Wang DD, O'Neill WW, and Eng MH. Procedural and mid-term outcomes of coronary protection: Insight from a single-center retrospective analysis. Catheterization and Cardiovascular Interventions 2020; 95:S222-S223.
Catheterization and cardiovascular interventions
Background: Coronary Obstruction is a rare but life-threatening complication of transcatheter aortic valve replacement (TAVR). Previous studies had shown coronary protection with guidewires and an undeployed coronary balloon or stent positioned in the coronary artery is helpful in the prompt diagnosis and treatment of coronary obstruction following TAVR. However, longer term data was limited.
Methods: We retrospectively analyzed the institutional TAVR and TVT registry at Henry Ford Hospital from January 2015 to August 2019 and identified patients underwent coronary protection before TAVR. Procedural efficacy (i.e. TAVR without coronary obstruction) and safety endpoints and intermediate-term outcomes including rate of target vessel re-intervention, myocardial infarction or stroke were studied.
Results: During the study period, 25 (2.1%) patients underwent TAVR with coronary protection including 10 (40%) valve-in-valve procedures. The mean STS score was 7.2%. A total of 28 coronary arteries were protected, with coronary heights of 9.0+/-1.8mm and virtual valve-to-coronary distance of 4+/-0.9mm. Procedural efficacy endpoint was met in 24/25 (96%) patients. A total of 13/28 (46.4%) coronaries were “chimney”-stented using 9 drug-eluting stents, 3 baremetal stents and 1 biliary stent. Procedure-related complications included 1 stent balloon entrapment requiring subsequent snaring and 1 distal stent edge dissection requiring additional stent implantation. After a mean follow-up period of 16.3 months, there was no target vessel re-intervention, myocardial infarction or stroke.
Conclusions: Our study showed promising mid-term coronary patency in low coronary height patients undergone TAVR with coronary protection. However, feasibility of repeat coronary intervention in target vessel remains uncertain.