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Coronary Obstruction After Transcatheter Aortic Valve Replacement

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Autores de IDIVAL

Autores ajenos al IDIVAL

  • Ojeda S
  • González-Manzanares R
  • Jiménez-Quevedo P
  • Piñón P
  • Asmarats L
  • Amat-Santos I
  • Fernández-Nofrerias E
  • Valle RD
  • Muñoz-García E
  • Ferrer-Gracia MC
  • Ruiz-Quevedo V
  • Regueiro A
  • Sanmiguel D
  • García-Blas S
  • Elízaga J
  • Baz JA
  • Romaguera R
  • Cruz-González I
  • Moreu J
  • Gheorghe LL
  • Salido L
  • Moreno R
  • Urbano C
  • Serra V
  • Pan M

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Abstract

BACKGROUND Coronary obstruction (CO) following transcatheter aortic valve replacement (TAVR) is a life-threatening complication, scarcely studied. OBJECTIVES The authors analyzed the incidence of CO after TAVR, presentation, management, and in-hospital and 1-year clinical outcomes in a large series of patients undergoing TAVR. METHODS Patients from the Spanish TAVI (Transcatheter Aortic Valve Implantation) registry who presented with CO in the procedure, during hospitalization or at follow-up were included. Computed tomography (CT) risk factors were assessed. In-hospital, 30-day, and 1-year all-cause mortality rates were analyzed and compared with patients without CO using logistic regression models in the overall cohort and in a propensity score-matched cohort. RESULTS Of 13,675 patients undergoing TAVR, 115 (0.80%) presented with a CO, mainly during the procedure (83.5%). The incidence of CO was stable throughout the study period (2009-2021), with a median annual rate of 0.8% (range 0.3%-1.3%). Preimplantation CT scans were available in 105 patients (91.3%). A combination of at least 2 CT-based risk factors was less frequent in native than in valve-in-valve patients (31.7% vs 78.3%; P < 0.01). Percutaneous coronary intervention was the treatment of choice in 100 patients (86.9%), with a technical success of 78.0%. In-hospital, 30-day, and 1-year mortality rates were higher in CO patients than in those without CO (37.4% vs 4.1%, 38.3% vs 4.3%, and 39.1% vs 9.1%, respectively; P < 0.001). CONCLUSIONS In this large, nationwide TAVR registry, CO was a rare, but often fatal, complication that did not decrease over time. The lack of identifiable predisposing factors in a subset of patients and the frequently challenging treatment when established may partly explain these findings. (J Am Coll Cardiol Intv 2023;16:1208-1217) & COPY; 2023 by the American College of Cardiology Foundation.

Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Datos de la publicación

ISSN/ISSNe:
1936-8798, 1876-7605

JACC-CARDIOVASCULAR INTERVENTIONS  ELSEVIER SCIENCE INC

Tipo:
Article
Páginas:
1208-1217
PubMed:
37225292
Enlace a otro recurso:
www.sciencedirect.com

Citas Recibidas en Web of Science: 20

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Keywords

  • coronary obstruction; percutaneous coronary intervention; transcatheter aortic valve replacement

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