Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement
| Autor: | Ramzi Khalil, J Bradley Oldemeyer, Jaffar M. Khan, Howard C. Herrmann, John Lisko, Robert J. Lederman, Adnan K. Chhatriwalla, Paul Mahoney, Rachel L Koch, David V. Daniels, Itsik Ben-Dor, Andrei Pop, Roger J. Laham, Emily Perdoncin, Brian Whisenant, Vasilis C. Babaliaros, Peter S. Fail, Gilbert H.L. Tang, James M. McCabe, Ming Zhang, Christian Spies, Adam B Greenbaum, Jeremiah P. Depta, Isaac George, Toby Rogers, Robert A. Leonardi, Lowell F. Satler, Cheng Zhang, Jonas Lanz, Shahram Yazdani, Jeffrey E. Cohen, Ron Waksman, Ashish Pershad, Shikhar Agarwal, Kamran I. Muhammad, Pinak B. Shah, George Hanzel |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Transcatheter aortic business.industry medicine.medical_treatment 030204 cardiovascular system & hematology medicine.disease Surgery 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Valve replacement Cohort medicine 030212 general & internal medicine Cardiology and Cardiovascular Medicine business Stroke Embolic protection Artery |
| Zdroj: | JACC: Cardiovascular Interventions. 14:941-948 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2021.02.035 |
| Popis: | Objectives This study sought to determine the safety of the BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) procedure. Background Transcatheter aortic valve replacement causes coronary artery obstruction in 0.7% of cases, with 40% to 50% mortality. BASILICA is a procedure to prevent coronary obstruction. Safety and feasibility in a large patient cohort is lacking. Methods The international BASILICA registry was a retrospective, multicenter, real-world registry of patients at risk of coronary artery obstruction undergoing BASILICA and transcatheter aortic valve replacement. Valve Academic Research Consortium-2 definitions were used to adjudicate events. Results Between June 2017 and December 2020, 214 patients were included from 25 centers in North America and Europe; 72.8% had bioprosthetic aortic valves and 78.5% underwent solo BASILICA. Leaflet traversal was successful in 94.9% and leaflet laceration in 94.4%. Partial or complete coronary artery obstruction was seen in 4.7%. Procedure success, defined as successful BASILICA traversal and laceration without mortality, coronary obstruction, or emergency intervention, was achieved in 86.9%. Thirty-day mortality was 2.8% and stroke was 2.8%, with 0.5% disabling stroke. Thirty-day death and disabling stroke were seen in 3.4%. Valve Academic Research Consortium-2 composite safety was achieved in 82.8%. One-year survival was 83.9%. Outcomes were similar between solo and doppio BASILICA, between native and bioprosthetic valves, and with the use of cerebral embolic protection. Conclusions BASILICA is safe, with low reported rates of stroke and death. BASILICA is feasible in the real-world setting, with a high procedure success rate and low rates of coronary artery obstruction. |
| Databáze: | OpenAIRE |
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