Transcatheter Aortic Valve Replacement in Patients at High Risk of Coronary Obstruction.

Autor:	Ahmad Y; Yale School of Medicine, Yale University, New Haven, Connecticut., Oakley L; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California., Yoon S; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California., Kaewkes D; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California., Chakravarty T; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California., Patel C; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California., Palmerini T; Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy., Bruno AG; Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy., Saia F; Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy., Testa L; Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy., Bedogni F; Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy., Chieffo A; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy., Montorfano M; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy., Bartorelli AL; Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy., Porto I; Cardiovascular Unit, Department of Internal Medicine and Specialties and IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy., Grube E; Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany., Nickenig G; Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany., Sinning JM; Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany., De Carlo M; Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy., Petronio AS; Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy., Barbanti M; Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy., Tamburino C; Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy., Iadanza A; Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy., Burzotta F; Department of Cardiology, Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy., Trani C; Department of Cardiology, Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy., Fraccaro C; Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy., Tarantini G; Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy., Aranzulla TC; Interventional Cardiology, Mauriziano Hospital, Torino, Italy., Musumeci G; Interventional Cardiology, Mauriziano Hospital, Torino, Italy., Stefanini GG; Cardio Center, Humanitas Research Hospital IRCCS, Milan, Italy., Taramasso M; Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland., Kim HS; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea., Codner P; Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel., Kornowski R; Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel., Pelliccia F; Department of Cardiovascular Sciences, La Sapienza University, Rome, Italy., Vignali L; UO Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy., Makkar RR; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Jazyk:	angličtina
Zdroj:	Journal of the Society for Cardiovascular Angiography & Interventions [J Soc Cardiovasc Angiogr Interv] 2022 Jun 22; Vol. 1 (4), pp. 100347. Date of Electronic Publication: 2022 Jun 22 (Print Publication: 2022).
DOI:	10.1016/j.jscai.2022.100347
Abstrakt:	Background: Coronary obstruction following transcatheter aortic valve replacement (TAVR) is a life-threatening complication. For patients at elevated risk, it is not known how valve choice is influenced by clinical and anatomic factors and how outcomes differ between valve platforms. For patients at high risk of coronary obstruction, we sought to describe the anatomical and clinical characteristics of patients treated with both balloon-expandable (BE) and self-expanding (SE) valves. Methods: This was a multicenter international registry of patients undergoing TAVR who are considered to be at high risk of coronary obstruction and receiving pre-emptive coronary protection. Results: A total of 236 patients were included. Patients receiving SE valves were more likely to undergo valve-in-valve procedures and also had smaller sinuses of Valsalva and valve-to-coronary distance. Three-year cardiac mortality was 21.6% with SE vs 3.7% with BE valves. This was primarily driven by increased rates of definite or probable coronary occlusion, which occurred in 12.1% of patients with SE valves vs 2.1% in patients with BE valves. Conclusions: In patients undergoing TAVR with coronary protection, those treated with SE valves had increased rates of clinical and anatomic features that increase the risk of coronary obstruction. These include an increased frequency of valve-in-valve procedures, smaller sinuses of Valsalva, and smaller valve-to-coronary distances. These patients were observed to have increased cardiac mortality compared with patients treated with BE valves, but this is likely due to their higher risk clinical and anatomic phenotypes rather than as a function of the valve type itself. Competing Interests: Dr Palmerini has received personal fees from Abbott and Edwards Lifesciences. Dr Oakley is a consultant for Edwards Lifesciences. Dr Burzotta received speaker’s fees from Abiomed, Abbott, and Medtronic. Mr Makkar has received research grants from 10.13039/100006520Edwards Lifesciences, 10.13039/100001316Abbott, 10.13039/100004374Medtronic, and 10.13039/100008497Boston Scientific; has served as the national principal investigator for Portico (Abbott) and Acurate (Boston Scientific) U.S. investigation device exemption trials; has received personal proctoring fees from Edwards Lifesciences; and has received travel support from Edwards Lifesciences, Abbott, and Boston Scientific. All other authors declare no conflict of interest. (© 2022 The Authors.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu