Coronary Protection to Prevent Coronary Obstruction During TAVR: A Multicenter International Registry.,JACC: Cardiovascular Interventions

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Coronary Protection to Prevent Coronary Obstruction During TAVR: A Multicenter International Registry.
JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2020-02-05 , DOI: 10.1016/j.jcin.2019.11.024
Tullio Palmerini ₁ , Tarun Chakravarty ₂ , Francesco Saia ₁ , Antonio G Bruno ₁ , Maria-Letizia Bacchi-Reggiani ₁ , Cinzia Marrozzini ₁ , Chinar Patel ₂ , Vivek Patel ₂ , Luca Testa ₃ , Francesco Bedogni ₃ , Marco Ancona ₄ , Matteo Montorfano ₄ , Alaide Chieffo ₄ , Paolo Olivares ₅ , Antonio L Bartorelli ₅ , Angelo Buscaglia ₆ , Italo Porto ₆ , Georg Nickenig ₇ , Eberhard Grube ₇ , Jan-Malte Sinning ₇ , Marco De Carlo ₈ , Anna Sonia Petronio ₈ , Marco Barbanti ₉ , Corrado Tamburino ₉ , Alessandro Iadanza ₁₀ , Francesco Burzotta ₁₁ , Carlo Trani ₁₁ , Chiara Fraccaro ₁₂ , Giuseppe Tarantini ₁₂ , Tiziana C Aranzulla ₁₃ , Mauro De Benedictis ₁₃ , Paolo Pagnotta ₁₄ , Giulio G Stefanini ₁₄ , Mizuki Miura ₁₅ , Maurizio Taramasso ₁₅ , Jee-Hoon Kang ₁₆ , Hyo-Soo Kim ₁₆ , Pablo Codner ₁₇ , Ran Kornowski ₁₇ , Francesco Pelliccia ₁₈ , Luigi Vignali ₁₉ , Nevio Taglieri ₁ , Gabriele Ghetti ₁ , Alessandro Leone ₁ , Nazzareno Galiè ₁ , Raj Makkar ₂

Affiliation

Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy.
Cedars-Sinai Medical Center, Los Angeles, California.
Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy.
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
Centro Cardiologico Monzino, University of Milan, Milan, Italy.
University of Genova, Cardiovascular Unit, Department of Internal Medicine and Specialties and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy.
Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy.
Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Interventional Cardiology, Mauriziano Hospital, Torino, Italy.
Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy.
Heart Valve Clinic, University Hospital of Zürich, Zürich, Switzerland.
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
Rabin Medical Center, Petah Tikva, Israel.
Department of Cardiovascular Sciences, La Sapienza University, Rome, Italy.
UO Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.

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.

中文翻译：

TAVR期间预防冠状动脉梗阻的冠脉保护：多中心国际注册中心。

目的本研究的目的是研究经导管主动脉瓣置换术（TAVR）后有高冠脉阻塞风险的患者中，通过预防性冠状动脉布线和跨冠状动脉口支架置入术来研究冠状动脉保护的安全性和有效性。背景技术TAVR后的冠状动脉阻塞是危及生命的并发症，具有较高的手术和短期死亡率。方法回顾性收集2011年4月至2019年2月间国际多中心注册中心的数据。结果在236例行预防性冠状动脉保护的冠状动脉保护患者中，有143例在瓣膜部署后最终在整个冠状动脉口植入了支架。在3年的随访中，接受支架的患者的心源性死亡率为7.8％，不接受支架的患者的心源性死亡率为15.7％（校正后的危险比：0.42；95％置信区间：0.14至1.28; p = 0.13）。接受支架的患者中有2个明确的支架血栓形成（0.9％），均发生在“瓣膜-瓣膜”手术的TAVR后。在未接受支架的患者中，有4次延迟冠状动脉闭塞（DCO）（4.3％），发生在拔丝后5分钟至6小时。瓣膜内瓣膜手术3例，自然主动脉瓣膜手术1例。75.0％的DCO患者存在虚拟经导管瓣膜与受保护的冠状动脉口之间的距离<4 mm，而无DCO的患者为30.4％（p = 0.19）。结论在高风险行TAVR的患者中，冠状动脉口的预防性支架植入与良好的中期生存率和低的支架血栓形成有关。

更新日期：2020-02-12

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