Valve-in-Valve Challenges: How to Avoid Coronary Obstruction
Autor: | Fernando Luiz de Melo Bernardi, Henrique Barbosa Ribeiro, Danny Dvir, Josep Rodés-Cabau |
---|---|
Rok vydání: | 2019 |
Předmět: |
0301 basic medicine
valve-in-valve lcsh:Diseases of the circulatory (Cardiovascular) system medicine.medical_specialty transcatheter heart valve Mini Review medicine.medical_treatment Cardiovascular Medicine 030204 cardiovascular system & hematology failed surgical bioprosthesis 03 medical and health sciences 0302 clinical medicine Valve replacement Internal medicine Occlusion medicine In patient Heart valve business.industry coronary obstruction Stent Valve in valve 030104 developmental biology medicine.anatomical_structure lcsh:RC666-701 Cardiology transcatheter aortic valve replacement Presentation (obstetrics) Cardiology and Cardiovascular Medicine Complication business |
Zdroj: | Frontiers in Cardiovascular Medicine, Vol 6 (2019) Frontiers in Cardiovascular Medicine |
ISSN: | 2297-055X |
Popis: | Coronary obstruction is a rare but life-threatening complication in patients undergoing transcatheter aortic valve replacement (TAVR). Aortic valve-in-valve (VIV) procedures to treat failed surgical bioprosthesis is associated with ~6-fold higher risk for coronary obstruction in certain situations. The primary mechanism consists in the occlusion of the coronary ostium by the dislodged leaflet from the bioprosthesis after deployment of the transcatheter heart valve (THV), which most commonly occurs during the index procedure, but in up to 1/3 of cases a delayed presentation ensues. The clinical presentation consists of severe hypotension and ECG changes in most of the patients, with very high mortality rates. Therefore, pre-procedural multi-slice computed tomography is crucial for identifying high-risk features, such as low coronary heights, shallow sinuses of Valsalva, and short virtual THV to coronary ostial distance (VTC). Also, some models of surgical bioprosthesis present an increased risk for this dreadful complication. Preemptive protective strategies with coronary wiring, with or without placement of an undeployed stent, could mitigate the risks associated with this complication in high-risk patients, even though studies are lacking. This review aims to take a clinical perspective on the challenges in avoiding this complication during VIV procedures. |
Databáze: | OpenAIRE |
Externí odkaz: |