Coronary obstruction following transcatheter aortic valve implantation: a systematic review

• Published in: JACC. Cardiovascular interventions 2013-05, Vol.6 (5), p.452-461
• Main Authors: Ribeiro, Henrique Barbosa, Nombela-Franco, Luis, Urena, Marina, Mok, Michael, Pasian, Sergio, Doyle, Daniel, DeLarochellière, Robert, Côté, Mélanie, Laflamme, Louis, DeLarochellière, Hugo, Allende, Ricardo, Dumont, Eric, Rodés-Cabau, Josep
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - therapy; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Cardiac Catheterization - mortality; Chi-Square Distribution; Coronary Artery Disease - diagnosis; Coronary Artery Disease - etiology; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Humans; Logistic Models; Male; Percutaneous Coronary Intervention; Prosthesis Design; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 1876-7605
• DOI: 10.1016/j.jcin.2012.11.014

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). Very few data exist on coronary obstruction after TAVI. 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. 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%. 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.