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Rigshospitalet - en del af Københavns Universitetshospital
Udgivet

Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

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  • Richard J Jabbour
  • Akihito Tanaka
  • Ariel Finkelstein
  • Michael Mack
  • Corrado Tamburino
  • Nicolas Van Mieghem
  • Ole de Backer
  • Luca Testa
  • Pamela Gatto
  • Paola Purita
  • Zouhair Rahhab
  • Verena Veulemans
  • Anja Stundl
  • Marco Barbanti
  • Roberto Nerla
  • Jan Malte Sinning
  • Danny Dvir
  • Giuseppe Tarantini
  • Molly Szerlip
  • Werner Scholtz
  • Smita Scholtz
  • Didier Tchetche
  • Fausto Castriota
  • Christian Butter
  • Lars Søndergaard
  • Mohamed Abdel-Wahab
  • Horst Sievert
  • Ottavio Alfieri
  • John Webb
  • Josep Rodés-Cabau
  • Antonio Colombo
  • Azeem Latib
Vis graf over relationer

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.

OriginalsprogEngelsk
TidsskriftJournal of the American College of Cardiology
Vol/bind71
Udgave nummer14
Sider (fra-til)1513-1524
Antal sider12
ISSN0735-1097
DOI
StatusUdgivet - 10 apr. 2018

ID: 56523204