Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement

• Published in: Journal of the American College of Cardiology Vol. 71; no. 14; pp. 1513 - 1524
• Main Authors: Jabbour, Richard J., Tanaka, Akihito, Finkelstein, Ariel, Mack, Michael, Tamburino, Corrado, Van Mieghem, Nicolas, de Backer, Ole, Testa, Luca, Gatto, Pamela, Purita, Paola, Rahhab, Zouhair, Veulemans, Verena, Stundl, Anja, Barbanti, Marco, Nerla, Roberto, Sinning, Jan Malte, Dvir, Danny, Tarantini, Giuseppe, Szerlip, Molly, Scholtz, Werner, Scholtz, Smita, Tchetche, Didier, Castriota, Fausto, Butter, Christian, Søndergaard, Lars, Abdel-Wahab, Mohamed, Sievert, Horst, Alfieri, Ottavio, Webb, John, Rodés-Cabau, Josep, Colombo, Antonio, Latib, Azeem
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 10.04.2018; Elsevier Limited
• Subjects: Angina pectoris; Angiography; Aortic valve; Balloon treatment; Calcification; Cardiology; Cardiovascular; Cardiovascular disease; Coronary artery; coronary obstruction; Coronary vessels; Heart diseases; Implants; Medical imaging; Myocardial infarction; Patients; Stents; TAVI; TAVR; transcatheter aortic valve replacement; Middle East; North America; Europe; ViV; TAVI; LCA; coronary obstruction; TAVR; CT; DCO; RCA; PCI; transcatheter aortic valve replacement; STEMI; SOV; CABG; computed tomography; sinus of Valsalva; left coronary artery; right coronary artery; percutaneous coronary intervention; delayed coronary obstruction; valve-in-valve; ST-segment elevation myocardial infarction; coronary artery bypass grafting
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2018.01.066

Delayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR). The aim of this study was to describe the incidence and pathophysiological features of DCO after TAVR, obtained from a large international multicenter registry. Data were retrospectively collected from an international multicenter registry consisting of 18 centers between November 2005 and December 2016. 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). 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. [Display omitted]