Palmerini, Tullio; Chakravarty, Tarun; Saia, Francesco; Bruno, Antonio G; Bacchi-Reggiani, Maria-Letizia; Marrozzini, Cinzia; Patel, Chinar; Patel, Vivek; Testa, Luca; Bedogni, Francesco; Ancona, Marco; Montorfano, Matteo; Chieffo, Alaide; Olivares, Paolo; Bartorelli, Antonio L; Buscaglia, Angelo; Porto, Italo; Nickenig, Georg; Grube, Eberhard; Sinning, Jan-Malte; De Carlo, Marco; Petronio, Anna Sonia; Barbanti, Marco; Tamburino, Corrado; Iadanza, Alessandro; Burzotta, Francesco; Trani, Carlo; Fraccaro, Chiara; Tarantini, Giuseppe; Aranzulla, Tiziana C; De Benedictis, Mauro; Pagnotta, Paolo; Stefanini, Giulio G; Miura, Mizuki; Taramasso, Maurizio; Kang, Jee-Hoon; Kim, Hyo-Soo; Codner, Pablo; Kornowski, Ran; Pelliccia, Francesco; Vignali, Luigi; Taglieri, Nevio; Ghetti, Gabriele; Leone, Alessandro; Galie, Nazzareno; Makkar, Raj
JACC. Cardiovascular interventions
2020Feb ; 179 ( 2 ) :.
PMID : 32061608
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Palmerini, Tullio - Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy. Electronic address: tulliopalmerini@hotmail.com.
Chakravarty, Tarun - Cedars-Sinai Medical Center, Los Angeles, California.
Saia, Francesco - Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy.
Bruno, Antonio G - Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy.
Bacchi-Reggiani, Maria-Letizia - Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy.
Marrozzini, Cinzia - Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy.
Patel, Chinar - Cedars-Sinai Medical Center, Los Angeles, California.
Patel, Vivek - Cedars-Sinai Medical Center, Los Angeles, California.
Testa, Luca - Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese,
Bedogni, Francesco - Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese,
Ancona, Marco - Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
Montorfano, Matteo - Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
Chieffo, Alaide - Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
Olivares, Paolo - Centro Cardiologico Monzino, University of Milan, Milan, Italy.
Bartorelli, Antonio L - Centro Cardiologico Monzino, University of Milan, Milan, Italy.
Buscaglia, Angelo - University of Genova, Cardiovascular Unit, Department of Internal Medicine and
Porto, Italo - University of Genova, Cardiovascular Unit, Department of Internal Medicine and
Nickenig, Georg - Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn,
Grube, Eberhard - Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn,
Sinning, Jan-Malte - Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn,
De Carlo, Marco - Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Petronio, Anna Sonia - Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Barbanti, Marco - Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of
Tamburino, Corrado - Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of
Iadanza, Alessandro - Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy.
Burzotta, Francesco - Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS,
Trani, Carlo - Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS,
Fraccaro, Chiara - Department of Cardiac, Thoracic and Vascular Sciences, University of Padua,
Tarantini, Giuseppe - Department of Cardiac, Thoracic and Vascular Sciences, University of Padua,
Aranzulla, Tiziana C - Interventional Cardiology, Mauriziano Hospital, Torino, Italy.
De Benedictis, Mauro - Interventional Cardiology, Mauriziano Hospital, Torino, Italy.
Pagnotta, Paolo - Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy.
Stefanini, Giulio G - Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy.
Miura, Mizuki - Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland.
Taramasso, Maurizio - Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland.
Kang, Jee-Hoon - Department of Internal Medicine and Cardiovascular Center, Seoul National
Kim, Hyo-Soo - Department of Internal Medicine and Cardiovascular Center, Seoul National
Codner, Pablo - Rabin Medical Center, Petah Tikva, Israel.
Kornowski, Ran - Rabin Medical Center, Petah Tikva, Israel.
Pelliccia, Francesco - Department of Cardiovascular Sciences, La Sapienza University, Rome, Italy.
Vignali, Luigi - UO Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
Taglieri, Nevio - Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy.
Ghetti, Gabriele - Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy.
Leone, Alessandro - Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy.
Galie, Nazzareno - Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy.
Makkar, Raj - Cedars-Sinai Medical Center, Los Angeles, California.
ABSTRACT
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. CI - Copyright ??2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
keyword
coronary obstruction;stent thrombosis;transcatheter valve replacement
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