Chimney Stenting for Coronary Occlusion During TAVR: Insights From the Chimney Registry.

Autor:	Mercanti F; University Hospital and SAOLTA University Health Care Group, Galway, Ireland., Rosseel L; University Hospital and SAOLTA University Health Care Group, Galway, Ireland., Neylon A; University Hospital and SAOLTA University Health Care Group, Galway, Ireland., Bagur R; Division of Cardiology, London Health Sciences Centre, School of Medicine & Dentistry, Western University, London, Ontario, Canada., Sinning JM; Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany., Nickenig G; Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany., Grube E; Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany., Hildick-Smith D; Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom., Tavano D; IRCCS Multimedica, Sesto San Giovanni, Milan, Italy., Wolf A; Department of Interventional Cardiology, Elisabeth Hospital Essen, Essen, Germany., Colonna G; Department of Cardiology, Vito Fazzi Hospital, Lecce, Italy., Latib A; Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy., Mitomo S; Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy., Petronio AS; Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy., Angelillis M; Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy., Tchétché D; Clinique Pasteur, Groupe Cardiovasculaire Interventionel, Toulouse, France., De Biase C; Clinique Pasteur, Groupe Cardiovasculaire Interventionel, Toulouse, France., Adamo M; Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy., Nejjari M; Hemodynamic Department, Centre Cardiologique du Nord, Saint Denis, France., Digne F; Hemodynamic Department, Centre Cardiologique du Nord, Saint Denis, France., Schäfer U; Department of General and Interventional Cardiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Amabile N; Department of Cardiology, Institut Mutualiste Montsouris, Paris, France., Achkouty G; Department of Cardiology, Institut Mutualiste Montsouris, Paris, France., Makkar RR; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California., Yoon SH; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California., Finkelstein A; Tel Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel., Dvir D; Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington., Jones T; Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington., Chevalier B; Institut Cardiovasculaire de Paris, Massy, France., Lefevre T; Institut Cardiovasculaire de Paris, Massy, France., Piazza N; McGill University Health Centre, Montreal, Quebec, Canada., Mylotte D; University Hospital and SAOLTA University Health Care Group, Galway, Ireland; National University of Ireland, Galway, Ireland. Electronic address: darrenmylotte@gmail.com.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2020 Mar 23; Vol. 13 (6), pp. 751-761.
DOI:	10.1016/j.jcin.2020.01.227
Abstrakt:	Objectives: The aim of this study was to determine the safety and efficacy of chimney stenting, a bailout technique to treat coronary artery occlusion (CAO). Background: CAO during transcatheter aortic valve replacement (TAVR) is a rare but often fatal complication. Methods: In the international Chimney Registry, patient and procedural characteristics and data on outcomes are retrospectively collected from patients who underwent chimney stenting during TAVR. Results: To date, 16 centers have contributed 60 cases among 12,800 TAVR procedures (0.5%). Chimney stenting was performed for 2 reasons: 1) due to the development of an established CAO (n = 25 [41.6%]); or 2) due to an impending CAO (n = 35 [58.3%]). The majority of cases (92.9%) had 1 or more classical risk factors for CAO. Upfront coronary protection was performed in 44 patients (73.3%). Procedural and in-hospital mortality occurred in 1 and 2 patients, respectively. Myocardial infarction (52.0% vs. 0.0%; p < 0.01), cardiogenic shock (52.0% vs. 2.9%; p < 0.01), and resuscitation (44.0% vs. 2.9%; p < 0.01) all occurred more frequently in patients with established CAO compared with those with impending CAO. The absence of upfront coronary protection was the sole independent risk factor for the combined endpoint of death, cardiogenic shock, or myocardial infarction. During a median follow-up time of 612 days (interquartile range: 405 to 842 days), 2 cases of stent failure were reported (1 in-stent restenosis, 1 possible late stent thrombosis) after 157 and 374 days. Conclusions: Chimney stenting appears to be an acceptable bailout technique for CAO, with higher event rates among those with established CAO and among those without upfront coronary protection. (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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