Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement
Journal of the American College of Cardiology , Volume 71 - Issue 14 p. 1513- 1524
Background: Delayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR). Objectives: The aim of this study was to describe the incidence and pathophysiological features of DCO after TAVR, obtained from a large international multicenter registry. Methods: Data were retrospectively collected from an international multicenter registry consisting of 18 centers between November 2005 and December 2016. Results: During the study period, 38 DCO (incidence 0.22%) cases were identified from a total of 17,092 TAVR procedures. DCO occurred more commonly after valve-in-valve procedures (0.89% vs. 0.18%; p < 0.001) and if self-expandable valves were used during the index procedure (0.36% vs. 0.11% balloon expandable; p < 0.01). DCO was most likely to occur ≤24 h after the TAVR procedure (47.4%; n = 18); 6 (15.8%) cases occurred between 24 h and ≤7 days, with the remaining 14 (36.8%) at ≥60 days. The most frequent presentation was cardiac arrest (31.6%; n = 12), followed by ST-segment elevation myocardial infarction (23.7%; n = 9). The left coronary artery was obstructed in most cases (92.1%; n = 35). Percutaneous coronary intervention was attempted in the majority of cases (74.3% left main; 60% right coronary), and stent implantation was successful in 68.8%. The overall in-hospital death rate was 50% (n = 19), and was higher if DCO occurred ≤7 days from the index procedure (62.5% vs. 28.6%; p = 0.09). Conclusions: DCO following TAVR is a rare phenomenon that is associated with a high in-hospital mortality rate. Clinicians should be aware that coronary obstruction can occur after the original TAVR procedure and have a low threshold for performing coronary angiography when clinically suspected.
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Jabbour, R.J. (Richard J.), Tanaka, A. (Akihito), Finkelstein, A. (Ariel), Mack, M.J, Tamburino, C. (Corrado), van Mieghem, N.M, … Latib, A. (2018). Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology, 71(14), 1513–1524. doi:10.1016/j.jacc.2018.01.066