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JACC Cardiovasc Interv. 2013 May;6(5):452-61. doi: 10.1016/j.jcin.2012.11.014. Epub 2013 Apr 17.

Coronary obstruction following transcatheter aortic valve implantation: a systematic review.

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1
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.

Abstract

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.

PMID:
23602458
DOI:
10.1016/j.jcin.2012.11.014
[Indexed for MEDLINE]
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