Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement From Computed Tomography to BASILICA

被引:117
作者
Lederman, Robert J. [1 ]
Babaliaros, Vasilis C. [2 ]
Rogers, Toby [1 ,3 ]
Khan, Jaffar M. [1 ]
Kamioka, Norihiko [2 ]
Dvir, Danny [4 ]
Greenbaum, Adam B. [2 ]
机构
[1] NHLBI, Cardiovasc Branch, Div Intramural Res, NIH, Bldg 10,Room 2C713,MSC 1538, Bethesda, MD 20892 USA
[2] Emory Univ, Atlanta, GA 30322 USA
[3] Medstar Washington Hosp Ctr, Washington, DC USA
[4] Univ Washington, Div Cardiol, Seattle, WA 98195 USA
关键词
cardiac computed tomography; coronary artery obstruction; transcatheter aortic valve replacement; transcatheter electrosurgery; valve-in-valve; virtual valve; virtual valve-to-coronary distance; CLINICAL-OUTCOMES; TRANSCAVAL ACCESS; IMPLANTATION; RISK; PROTECTION; LACERATION; INSIGHTS; CLOSURE; LEAFLET;
D O I
10.1016/j.jcin.2019.04.052
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Coronary artery obstruction is an uncommon but devastating complication of transcatheter aortic valve replacement (TAVR). Computed tomography appears to be a sensitive but nonspecific predictor of coronary artery obstruction. Transcatheter approaches to prevent and treat coronary artery obstruction, such as "snorkel" stenting, are unsatisfactory because of serious early and late ischemic complications. Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (BASILICA) is an early-stage transcatheter procedure to prevent coronary artery obstruction. It works by splitting the native or bioprosthetic leaflets so that they splay after TAVR and preserve coronary artery inflow. Because of the paucity of suitable alternatives, there is interest in the BASILICA technique despite its infancy. This tutorial review summarizes current thinking about how to predict and prevent coronary artery obstruction using BASILICA. First, the authors depict the main pathophysiological mechanisms of TAVR-associated coronary artery obstruction, along with the factors thought to contribute to coronary obstruction. Next, the authors provide a step-by-step guide to analyzing pre-procedural computed tomographic findings to assess obstruction risk and, if desirable, to plan BASILICA. Next, the authors describe the mechanisms underlying transcatheter electrosurgery. Finally, they provide step-by-step guidance on how to perform the procedure, along with a required equipment list. Published by Elsevier on behalf of the American College of Cardiology Foundation.
引用
收藏
页码:1197 / 1216
页数:20
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