Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement

被引：171

作者：

Jabbour, Richard J. ^{[1
,2
,3
]}

Tanaka, Akihito ^{[1
,2
]}

Finkelstein, Ariel ^{[4
]}

Mack, Michael ^{[5
,25
]}

Tamburino, Corrado ^{[6
]}

Van Mieghem, Nicolas ^{[7
]}

de Backer, Ole ^{[8
]}

Testa, Luca ^{[9
]}

Gatto, Pamela ^{[10
]}

Purita, Paola ^{[11
]}

Rahhab, Zouhair ^{[7
]}

Veulemans, Verena ^{[12
]}

Stundl, Anja ^{[13
]}

Barbanti, Marco ^{[6
]}

Nerla, Roberto ^{[14
]}

Sinning, Jan Malte ^{[13
]}

Dvir, Danny ^{[15
,16
]}

Tarantini, Giuseppe ^{[11
]}

Szerlip, Molly ^{[5
]}

Scholtz, Werner ^{[17
]}

Scholtz, Smita ^{[17
]}

Tchetche, Didier ^{[10
]}

Castriota, Fausto ^{[14
]}

Butter, Christian ^{[18
]}

Sondergaard, Lars ^{[8
]}

Abdel-Wahab, Mohamed ^{[19
,20
,21
]}

Sievert, Horst ^{[22
]}

Alfieri, Ottavio ^{[23
]}

Webb, John ^{[15
,16
]}

Rodes-Cabau, Josep ^{[24
]}

Colombo, Antonio ^{[1
,2
]}

Latib, Azeem ^{[1
,2
]}

机构：

[1] EMO GVM Ctr Cuore Columbus, Intervent Cardiol Unit, Milan, Italy

[2] Ist Sci San Raffaele, Intervent Cardiol Unit, Via Olgettina 60, I-20132 Milan, Italy

[3] Imperial Coll London, London, England

[4] Tel Aviv Med Ctr & Sch Med, Intervent Cardiol, Tel Aviv, Israel

[5] Heart Hosp Baylor Plano, Plano, TX USA

[6] Univ Catania, Ferrarotto Hosp, Cardiovasc Dept, Catania, Italy

[7] Erasmus MC, Thoraxctr, Rotterdam, Netherlands

[8] Copenhagen Univ Hosp, Rigshosp, Heart Ctr, Copenhagen, Denmark

[9] IRCCS Pol San Donato, Dept Cardiol, Milan, Italy

[10] Clin Pasteur, Toulouse, France

[11] Univ Padua, Dept Cardiac Thorac & Vasc Sci, Cardiol Unit, Sch Med, Padua, Italy

[12] Univ Hosp, Dept Cardiol Pulmonol & Angiol, Dusseldorf, Germany

[13] Univ Hosp Bonn, Heart Ctr Bonn, Dept Med 2, Bonn, Germany

[14] GVM Maria Cecilia Hosp, Intervent Cardiol Unit, Cotignola, Italy

[15] Univ British Columbia, St Pauls Hosp, Dept Med Imaging, Vancouver, BC, Canada

[16] Univ British Columbia, St Pauls Hosp, Div Cardiol, Vancouver, BC, Canada

[17] Ruhr Univ Bochum, Heart & Diabet Ctr North Rhine Westphalia, Dept Cardiol, Oeynhausen, Germany

[18] Heart Ctr Brandenburg, Dept Cardiol, Bernau Bei Berlin, Germany

[19] Univ Kiel, Acad Teaching Hosp, Segeberger Kliniken GmbH, Heart Ctr, Bad Segeberg, Germany

[20] Univ Lubeck, Acad Teaching Hosp, Segeberger Kliniken GmbH, Heart Ctr, Bad Segeberg, Germany

[21] Univ Hamburg, Acad Teaching Hosp, Segeberger Kliniken GmbH, Heart Ctr, Bad Segeberg, Germany

[22] Sankt Katharinen Krankenhaus, CardioVasc Ctr Frankfurt CVC, Frankfurt, Germany

[23] Ist Sci San Raffaele, Cardiothorac Unit, Milan, Italy

[24] Quebec Heart & Lung Inst, Quebec City, PQ, Canada

[25] Partner 3 Trial, Quebec City, PQ, Canada

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2018年 / 71卷 / 14期

关键词：

coronary obstruction; TAVI; TAVR; transcatheter aortic valve replacement; BIOPROSTHETIC SURGICAL VALVES; CLINICAL-OUTCOMES; RISK PATIENTS; IMPLANTATION; REGISTRY; INSIGHTS; PATIENT;

D O I：

10.1016/j.jacc.2018.01.066

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (c) 2018 Published by Elsevier on behalf of the American College of Cardiology Foundation.

引用

页码：1513 / 1524

页数：12

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