Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement
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....
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| Published in | Journal of the American College of Cardiology Vol. 71; no. 14; pp. 1513 - 1524 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
10.04.2018
Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0735-1097 1558-3597 1558-3597 |
| DOI | 10.1016/j.jacc.2018.01.066 |
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| Abstract | 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.
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| AbstractList | 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. 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] BackgroundDelayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR).ObjectivesThe aim of this study was to describe the incidence and pathophysiological features of DCO after TAVR, obtained from a large international multicenter registry.MethodsData were retrospectively collected from an international multicenter registry consisting of 18 centers between November 2005 and December 2016.ResultsDuring 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).ConclusionsDCO 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. Delayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR).BACKGROUNDDelayed 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.OBJECTIVESThe 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.METHODSData 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).RESULTSDuring 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.CONCLUSIONSDCO 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. AbstractBackgroundDelayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR). ObjectivesThe aim of this study was to describe the incidence and pathophysiological features of DCO after TAVR, obtained from a large international multicenter registry. MethodsData were retrospectively collected from an international multicenter registry consisting of 18 centers between November 2005 and December 2016. ResultsDuring 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). ConclusionsDCO 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. |
| Author | de Backer, Ole Tchetche, Didier Rodés-Cabau, Josep Sievert, Horst Gatto, Pamela Barbanti, Marco Scholtz, Smita Dvir, Danny Butter, Christian Søndergaard, Lars Webb, John Colombo, Antonio Alfieri, Ottavio Tamburino, Corrado Sinning, Jan Malte Scholtz, Werner Abdel-Wahab, Mohamed Jabbour, Richard J. Rahhab, Zouhair Finkelstein, Ariel Mack, Michael Latib, Azeem Stundl, Anja Purita, Paola Testa, Luca Tanaka, Akihito Tarantini, Giuseppe Van Mieghem, Nicolas Szerlip, Molly Castriota, Fausto Veulemans, Verena Nerla, Roberto |
| Author_xml | – sequence: 1 givenname: Richard J. surname: Jabbour fullname: Jabbour, Richard J. organization: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy – sequence: 2 givenname: Akihito surname: Tanaka fullname: Tanaka, Akihito organization: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy – sequence: 3 givenname: Ariel surname: Finkelstein fullname: Finkelstein, Ariel organization: Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel – sequence: 4 givenname: Michael surname: Mack fullname: Mack, Michael organization: The Heart Hospital Baylor Plano, Plano, Texas – sequence: 5 givenname: Corrado surname: Tamburino fullname: Tamburino, Corrado organization: Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy – sequence: 6 givenname: Nicolas surname: Van Mieghem fullname: Van Mieghem, Nicolas organization: Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands – sequence: 7 givenname: Ole surname: de Backer fullname: de Backer, Ole organization: Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark – sequence: 8 givenname: Luca surname: Testa fullname: Testa, Luca organization: Department of Cardiology, IRCCS Pol. San Donato, Milan, Italy – sequence: 9 givenname: Pamela surname: Gatto fullname: Gatto, Pamela organization: Clinique Pasteur, Toulouse, France – sequence: 10 givenname: Paola surname: Purita fullname: Purita, Paola organization: Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy – sequence: 11 givenname: Zouhair surname: Rahhab fullname: Rahhab, Zouhair organization: Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands – sequence: 12 givenname: Verena surname: Veulemans fullname: Veulemans, Verena organization: Department of Cardiology, Pulmonology, and Angiology, University Hospital, Düsseldorf, Germany – sequence: 13 givenname: Anja surname: Stundl fullname: Stundl, Anja organization: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany – sequence: 14 givenname: Marco surname: Barbanti fullname: Barbanti, Marco organization: Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy – sequence: 15 givenname: Roberto surname: Nerla fullname: Nerla, Roberto organization: Interventional Cardiology Unit, GVM Maria Cecilia Hospital, Cotignola, Italy – sequence: 16 givenname: Jan Malte surname: Sinning fullname: Sinning, Jan Malte organization: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany – sequence: 17 givenname: Danny surname: Dvir fullname: Dvir, Danny organization: Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada – sequence: 18 givenname: Giuseppe surname: Tarantini fullname: Tarantini, Giuseppe organization: Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy – sequence: 19 givenname: Molly surname: Szerlip fullname: Szerlip, Molly organization: The Heart Hospital Baylor Plano, Plano, Texas – sequence: 20 givenname: Werner surname: Scholtz fullname: Scholtz, Werner organization: Department of Cardiology, Heart and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Oeynhausen, Germany – sequence: 21 givenname: Smita surname: Scholtz fullname: Scholtz, Smita organization: Department of Cardiology, Heart and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Oeynhausen, Germany – sequence: 22 givenname: Didier surname: Tchetche fullname: Tchetche, Didier organization: Clinique Pasteur, Toulouse, France – sequence: 23 givenname: Fausto surname: Castriota fullname: Castriota, Fausto organization: Interventional Cardiology Unit, GVM Maria Cecilia Hospital, Cotignola, Italy – sequence: 24 givenname: Christian surname: Butter fullname: Butter, Christian organization: Department of Cardiology, Heart Center Brandenburg, Bernau bei Berlin, Germany – sequence: 25 givenname: Lars surname: Søndergaard fullname: Søndergaard, Lars organization: Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark – sequence: 26 givenname: Mohamed surname: Abdel-Wahab fullname: Abdel-Wahab, Mohamed organization: Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany – sequence: 27 givenname: Horst surname: Sievert fullname: Sievert, Horst organization: CardioVascular Center Frankfurt CVC, Sankt Katharinen Krankenhaus, Frankfurt, Germany – sequence: 28 givenname: Ottavio surname: Alfieri fullname: Alfieri, Ottavio organization: Cardiothoracic Unit, San Raffaele Scientific Institute, Milan, Italy – sequence: 29 givenname: John surname: Webb fullname: Webb, John organization: Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada – sequence: 30 givenname: Josep surname: Rodés-Cabau fullname: Rodés-Cabau, Josep organization: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada – sequence: 31 givenname: Antonio surname: Colombo fullname: Colombo, Antonio organization: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy – sequence: 32 givenname: Azeem surname: Latib fullname: Latib, Azeem email: alatib@gmail.com organization: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29622157$$D View this record in MEDLINE/PubMed |
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| Snippet | Delayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR).
The aim of this... AbstractBackgroundDelayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR).... BackgroundDelayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement... Delayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR).BACKGROUNDDelayed... |
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| SubjectTerms | 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 |
| Title | Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement |
| URI | https://www.clinicalkey.com/#!/content/1-s2.0-S0735109718304509 https://www.clinicalkey.es/playcontent/1-s2.0-S0735109718304509 https://dx.doi.org/10.1016/j.jacc.2018.01.066 https://www.ncbi.nlm.nih.gov/pubmed/29622157 https://www.proquest.com/docview/2020773195 https://www.proquest.com/docview/2022995341 |
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