Coronary Access After TAVR
Autor: | Sung-Han Yoon, Tomoki Ochiai, Wen Cheng, Nir Flint, Tarun Chakravarty, Ripandeep Tiwana, Vivek Patel, Mamoo Nakamura, Sahar Mahani, Raj Makkar, Danon Kaewkes, Navjot Sekhon |
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Rok vydání: | 2020 |
Předmět: |
Male
Aortic valve Cardiac Catheterization medicine.medical_specialty Computed Tomography Angiography medicine.medical_treatment 030204 cardiovascular system & hematology Coronary Angiography Prosthesis Design Severity of Illness Index Transcatheter Aortic Valve Replacement Coronary artery disease 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Left coronary artery Valve replacement Predictive Value of Tests Risk Factors Internal medicine medicine.artery Humans Medicine Registries 030212 general & internal medicine Heart valve Aged Retrospective Studies Aged 80 and over business.industry Coronary Stenosis Percutaneous coronary intervention Aortic Valve Stenosis medicine.disease Coronary Vessels Treatment Outcome medicine.anatomical_structure Aortic Valve Heart Valve Prosthesis Aortic valve stenosis Right coronary artery Cardiology Female Cardiology and Cardiovascular Medicine business |
Zdroj: | JACC: Cardiovascular Interventions. 13:693-705 |
ISSN: | 1936-8798 0231-8342 |
DOI: | 10.1016/j.jcin.2020.01.216 |
Popis: | Objectives The aim of this study was to assess the incidence of unfavorable coronary access after transcatheter aortic valve replacement (TAVR) using post-implantation computed tomography (CT). Background Real-world data regarding coronary access after TAVR assessed using post-implantation CT are scarce. Methods Post-TAVR CT of 66 patients treated with Evolut R or Evolut PRO valves and 345 patients treated with SAPIEN 3 valves were analyzed. The distance from inflow of the transcatheter heart valve (THV) to the coronary ostia and the overlap between THV commissures and the coronary ostia were assessed. Coronary access was defined as unfavorable if the coronary ostium was below the skirt or in front of the THV commissural posts above the skirt in each coronary artery. Results CT-identified features of unfavorable coronary access were observed in 34.8% (n = 23) for the left coronary artery and 25.8% (n = 17) for the right coronary artery in the Evolut R/Evolut PRO group, while those percentages were 15.7% (n = 54) for the left coronary artery and 8.1% (n = 28) for the right coronary artery in the SAPIEN 3 group. In the Evolut R/Evolut PRO group, 16 coronary engagements were performed after TAVR, while 64 coronary engagements were performed in the SAPIEN 3 group after TAVR. In an engagement-level analysis, the success rates of selective coronary engagement were significantly lower in patients with CT-identified features of unfavorable coronary access compared with those with favorable coronary access in both the Evolut R/Evolut PRO (0.0% vs. 77.8%; p = 0.003) and SAPIEN 3 (33.3% vs. 91.4%; p = 0.003) groups. Conclusions Coronary access may be challenging in a significant proportion of patients after TAVR. THVs with low skirt or commissure height and large open cells that are designed to achieve commissure-to-commissure alignment with the native aortic valve may facilitate future coronary access. (Assessment of Transcatheter and Surgical Aortic Bioprosthetic Valve Thrombosis and Its Treatment With Anticoagulation [RESOLVE]; NCT02318342) |
Databáze: | OpenAIRE |
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