Chimney Stenting During Transcatheter Aortic Valve Implantation

Abstract

Acute coronary artery obstruction is a rare but life-threatening complication of transcatheter aortic valve implantation. In patients at risk of coronary artery obstruction, pre-emptive coronary artery protection with a coronary wire, balloon or stent provides a bailout treatment option. The authors describe the steps involved in performing chimney stenting and summarise the short- and long-term outcome data associated with this technique.

Transcatheter aortic valve-in-valve implantation for failed surgical bioprostheses: results from Polish Transcatheter Aortic Valve-in-Valve Implantation (ViV-TAVI) Registry

“…Patient prosthesis mismatch (PPM) was found in 32 patients (25%) (Table 4). However, implantation of supra-annular TAV resulted in lower average PG (14 [10.5-20] vs. intra-annular design prosthesis, 19 [16][17][18][19][20][21][22][23][24][25][26] mmHg, P=0.004) (Figure 3).…”

“…However, it can be prevented by thorough pre-procedural CT analysis and even if the risk is substantial preventive measures can be taken, e.g. simultaneous coronary stenting, (chimney stenting) or SAV leaflet(s) laceration (BASILICA) [16,17]. In the present dataset coronary obstruction was rare (1.5%), slightly lower compared to the recent VIVID registry, which is probably due to the lower percentage of stented SAVs with externally mounted leaflets reported in our population (8.5%), that are most prone to cause occlusion after TAV implantation [15].…”

“…SAV stenosis at baseline compared to regurgitation or mixed disease was associated with higher average PG (median [IQR] 16[13.5-22.5] vs. 14.5[10][11][12][13][14][15][16][17][18][19] mmHg, P=0.004). ViV-TAVI performed in small SAV's (≤21 mm) was associated with smaller post-procedural effective orifice area (EOA) as compared with bigger SAV's (1.4 [1.2-1.6] vs. 1.58 [1.45-1.7], P=0.005) (Supplementary material, FigureS2, panel 2).…”

Coronary protection for the small left coronary sinus during transcatheter aortic valve replacement: a case report

“…Surgical aortic valve replacement should be considered first if patients were identified with high risks of CO. Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) procedure could be a good choice for some patients under TAVR with CO. 9 However, the BASILICA procedure was not widely used in clinical practice because of its complexity in China. As a result, as an alternative procedure that could also avoid CO, 6 , 10 TAVR combined with preliminary coronary protection (CP) by chimney stenting are more commonly carried out.…”

“…Both TAVR combined with bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) procedure or prophylactic coronary protection (CP) by chimney stent could be potential treatment options for high-risk CO patients. 6 , 7 This case showed a patient with a small left coronary sinus, a rare congenital malformation that had high risks of CO during TAVR. The VitaFlow system (MicroPort, Shanghai, China), a novel self-expanding prosthetic valve, 8 was used to successfully complete the TAVR with the chimney stent technique to protect the left coronary.…”