Coronary Protection to Prevent Coronary Obstruction During TAVR A Multicenter International Registry

被引：64

作者：

Palmerini, Tullio ^{[1
]}

Chakravarty, Tarun ^{[2
]}

Saia, Francesco ^{[1
]}

Bruno, Antonio G. ^{[1
]}

Bacchi-Reggiani, Maria-Letizia ^{[1
]}

Marrozzini, Cinzia ^{[1
]}

Patel, Chinar ^{[2
]}

Patel, Vivek ^{[2
]}

Testa, Luca ^{[3
]}

Bedogni, Francesco ^{[3
]}

Ancona, Marco ^{[4
]}

Montorfano, Matteo ^{[4
]}

Chieff, Alaide ^{[4
]}

Olivares, Paolo ^{[5
]}

Bartorelli, Antonio L. ^{[5
]}

Buscaglia, Angelo ^{[6
,7
]}

Porto, Italo ^{[6
,7
]}

Nickenig, Georg ^{[8
]}

Grube, Eberhard ^{[8
]}

Sinning, Jan-Malte ^{[8
]}

De Carlo, Marco ^{[9
]}

Petronio, Anna Sonia ^{[9
]}

Barbanti, Marco ^{[10
]}

Tamburino, Corrado ^{[10
]}

Iadanza, Alessandro ^{[11
]}

Burzotta, Francesco ^{[12
]}

Trani, Carlo ^{[12
]}

Fraccaro, Chiara ^{[13
]}

Tarantini, Giuseppe ^{[13
]}

Aranzulla, Tiziana C. ^{[14
]}

De Benedictis, Mauro ^{[14
]}

Pagnotta, Paolo ^{[15
]}

Stefanini, Giulio G. ^{[15
]}

Miura, Mizuki ^{[16
]}

Taramasso, Maurizio ^{[16
]}

Kang, Jee-Hoon ^{[17
,18
]}

Kim, Hyo-Soo ^{[17
,18
]}

Codner, Pablo ^{[19
]}

Kornowski, Ran ^{[19
]}

Pelliccia, Francesco ^{[20
]}

Vignali, Luigi ^{[21
]}

Taglieri, Nevio ^{[1
]}

Ghetti, Gabriele ^{[1
]}

Leone, Alessandro ^{[1
]}

Galie, Nazzareno ^{[1
]}

Makkar, Raj ^{[2
]}

机构：

[1] Policlinico S Orsola, Cardio Toraco Vascolare, Bologna, Italy

[2] Cedars Sinai Med Ctr, Los Angeles, CA USA

[3] IRCCS Policlin S Donato, Coronary Revascularisat Unit, San Donato Milanese, Italy

[4] Ist Sci San Raffaele, Intervent Cardiol Unit, Milan, Italy

[5] Univ Milan, Ctr Cardiol Monzino, Milan, Italy

[6] Univ Genoa, Dept Internal Med & Specialties, Cardiovasc Unit, Genoa, Italy

[7] IRCCS Osped Policlin San Martino, Genoa, Italy

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

[9] Azienda Osped Univ Pisana, Pisa, Italy

[10] Univ Catania, Policlin Vittorio Emanuele Hosp, Div Cardiol, Catania, Italy

[11] Azienda Osped Univ Senese, Policlin Scotte, Siena, Italy

[12] Univ Cattolica Sacro Cuore, Inst Cardiol, Fdn Policlin Univ Gemelli IRCCS, Rome, Italy

[13] Univ Padua, Dept Cardiac Thorac & Vasc Sci, Padua, Italy

[14] Mauriziano Hosp, Intervent Cardiol, Turin, Italy

[15] Humanitas Res Hosp IRCCS, Cardio Ctr, Rozzano Milan, Italy

[16] Univ Zurich Hosp, Heart Valve Clin, Zurich, Switzerland

[17] Seoul Natl Univ Hosp, Dept Internal Med, Seoul, South Korea

[18] Seoul Natl Univ Hosp, Cardiovasc Ctr, Seoul, South Korea

[19] Rabin Med Ctr, Petah Tiqwa, Israel

[20] Sapienza Univ, Dept Cardiovasc Sci, Rome, Italy

[21] Azienda Osped Univ Parma, UO Cardiol, Parma, Italy

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2020年 / 13卷 / 06期

关键词：

coronary obstruction; stent; thrombosis; transcatheter aortic valve replacement; TRANSCATHETER AORTIC-VALVE; CLINICAL-OUTCOMES; IMPLANTATION; REPLACEMENT; STENT; RISK; INSIGHTS;

D O I：

10.1016/j.jcin.2019.11.024

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES The aim of this study was to investigate the safety and efficacy of coronary protection by preventive coronary wiring and stenting across the coronary ostia in patients at high risk for coronary obstruction after transcatheter aortic valve replacement (TAVR). BACKGROUND Coronary obstruction following TAVR is a life-threatening complication with high procedural and short-term mortality. METHODS Data were collected retrospectively from a multicenter international registry between April 2011 and February 2019. RESULTS Among 236 patients undergoing coronary protection with preventive coronary wiring, 143 had eventually stents implanted across the coronary ostia after valve deployment. At 3-year follow-up, rates of cardiac death were 7.8% in patients receiving stents and 15.7% in those not receiving stents (adjusted hazard ratio: 0.42; 95% confidence interval: 0.14 to 1.28; p = 0.13). There were 2 definite stent thromboses (0.9%) in patients receiving stents, both occurring after TAVR in "valve-in-valve" procedures. In patients not receiving stents, there were 4 delayed coronary occlusions (DCOs) (4.3%), occurring from 5 min to 6 h after wire removal. Three cases occurred in valve-in-valve procedures and 1 in a native aortic valve procedure. Distance between the virtual transcatheter valve and the protected coronary ostia <4 mm was present in 75.0% of patients with DCO compared with 30.4% of patients without DCO (p = 0.19). CONCLUSIONS In patients undergoing TAVR at high risk for coronary obstruction, preventive stent implantation across the coronary ostia is associated with good mid-term survival rates and low rates of stent thrombosis. Patients undergoing coronary protection with wire only have a considerable risk for DCO. (C) 2020 by the American College of Cardiology Foundation.

引用

页码：739 / 747

页数：9

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