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

JACC. Cardiovascular interventions

Authors: Tullio Palmerini, Tarun Chakravarty, Francesco Saia, Antonio G Bruno, Maria-Letizia Bacchi-Reggiani, Cinzia Marrozzini, Chinar Patel, Vivek Patel, Luca Testa, Francesco Bedogni, Marco Ancona, Matteo Montorfano, Alaide Chieffo, Paolo Olivares, Antonio L Bartorelli, Angelo Buscaglia, Italo Porto, Georg Nickenig, Eberhard Grube, Jan-Malte Sinning, Marco De Carlo, Anna Sonia Petronio, Marco Barbanti, Corrado Tamburino, Alessandro Iadanza, Francesco Burzotta, Carlo Trani, Chiara Fraccaro, Giuseppe Tarantini, Tiziana C Aranzulla, Mauro De Benedictis, Paolo Pagnotta, Giulio G Stefanini, Mizuki Miura, Maurizio Taramasso, Jee-Hoon Kang, Hyo-Soo Kim, Pablo Codner, Ran Kornowski, Francesco Pelliccia, Luigi Vignali, Nevio Taglieri, Gabriele Ghetti, Alessandro Leone, Nazzareno Galiè, Raj Makkar

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.

Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PMID: 32061608

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