Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement

Jabbour, Richard J.; Tanaka, Akihito; Finkelstein, Ariel; Mack, Michael J.; Tamburino, Corrado; Mieghem, Nicolas Van; Backer, Ole De; Testa, Luca; Gatto, Pamela; Purita, Paola; Rahhab, Zouhair; Veulemans, Verena; Stundl, Anja; Barbanti, Marco; Nerla, Roberto; Sinning, Jan Malte; Dvir, Danny; Tarantini, Giuseppe; Szerlip, Molly; Scholtz, Werner; Scholtz, Smita; Tchétché, Didier; Castriota, Fausto; Butter, Christian; Søndergaard, Lars; Abdel‐Wahab, Mohamed; Sievert, Horst; Alfieri, Ottavio; Webb, John G.; Rodés‐Cabau, Josep; Colombo, Antonio; Latib, Azeem

doi:10.1016/j.jacc.2018.01.066

Cited by 174 publications

(105 citation statements)

References 23 publications

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“…Another challenge for valve in valve procedure in degenerated prosthesis is a risk of coronary obstruction, which occurs in 3.5% of all cases . Mortality in such cases may be as high as 50% and this complication may remain undiagnosed without autopsy . This life‐threatening complication is extremely high in small Mitroflow Sorin valves, due to the long leaflets mounted externally over the stent .…”

Section: Discussionmentioning

confidence: 99%

Severe structural deterioration of small aortic bioprostheses treated with valve-in-valve transcatheter aortic valve implantation

et al. 2019

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Objectives The aim of this study was to evaluate outcomes of valve‐in‐valve transcatheter aortic valve implantation (VIV‐TAVI) in patients with degenerated small bioprostheses. Methods Outcomes of consecutive 27 high‐risk patients (logistic EuroSCORE 35.5 ± 18.5%) with a mean age of 81.0 ± 5.9 years who underwent VIV‐TAVI for degenerated small bioprostheses (19 mm‐11.1%; 20 mm‐11.1%; 21 mm‐77.8%) were analyzed. Medtronic CoreValve (n = 11) or CoreValve Evolut‐R prostheses (n = 16) were implanted. Follow‐up was 3.2 ± 2.0 years. Results Early mortality was 11.1%. One patient died intraoperatively due to left ventricle perforation, two others during the in‐hospital period as a result of sudden cardiac death and pulmonary embolism. VIV‐TAVI was completed in 26 cases (96.3%—success rate). Two patients required pacemaker implantation. Acute kidney injury occurred in two other patients. At discharge, mean transvalvular gradient was 19.2 ± 9.5 mmHg and in 25.9% of patients mean gradient exceeded 20 mmHg. Overall mortality was 25.9% and mortality from cardiac or unknown causes at 18.5%. Ninety percent of survivors were in New York Heart Association (NYHA) class I or II. Conclusions Transfemoral VIV‐TAVI in patients with small, degenerated bioprostheses appears to be a promising alternative to surgery. Although the vast majority of patients have significant improvement in their NYHA class, the rate of persistent, residual gradients is relatively high and will need to be followed closely with serial echocardiograms.

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Section: Discussionmentioning

confidence: 99%

Severe structural deterioration of small aortic bioprostheses treated with valve-in-valve transcatheter aortic valve implantation

et al. 2019

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“…However, the efficacy of VIV procedures has been reported to be lower in specific settings [8, 9]. Worse outcomes are in fact reported for patients with small surgical valves and in those with a stenotic presentation [8].…”

Section: Discussionmentioning

confidence: 99%

“…Coronary obstructions are usually secondary to the displacement of the leaflet of the underlying valve toward a coronary ostium, most commonly the left one [9–12], as in the case presented.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the anatomic features known to possibly predispose to coronary obstruction in the case of native valve procedures, namely shallow sinus of Valsalva or low-lying coronary ostium [9, 10], in VIV the risk is also dependent on the characteristics of the previously implanted surgical bioprosthesis and on the relationship of its leaflets and posts with the coronary ostia [2]. …”

Section: Discussionmentioning

confidence: 99%

“…[9]). No other cause for the sudden death experienced by our patient except for LMCO obstruction was demonstrated by an autoptic examination.…”

Section: Discussionmentioning

confidence: 99%

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Sudden death after valve-in-valve procedure due to delayed coronary obstruction: a case report

et al. 2018

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BackgroundValve-in-valve transcatheter aortic valve implantation for degenerated aortic bioprostheses is an effective option for patients at high risk for redo surgery, even if it may be burdened by complications more common in specific settings, such as, coronary artery obstruction.Case presentationWe present the case of a Caucasic 84-year-old woman with degeneration of a previously implanted aortic Mitroflow bioprosthesis. She underwent a valve-in-valve transcatheter aortic valve implantation with a CoreValve® bioprosthesis. End-procedure coronary angiography demonstrated maintained perfusion of both coronary arteries. However, few hours later, she experienced sudden cardiac death. An autopsy showed that Mitroflow prosthesis leaflets were higher than the left main coronary ostium, and no other possible cause for the sudden death. Fatality was thus ascribed to left main coronary ostium obstruction due to apposition of the Mitroflow leaflet pushed upward by the late expansion of CoreValve®.ConclusionsCoronary artery obstruction is a frequently fatal complication which usually presents just after valve implantation, but, as reported in our case, it may also have a delayed presentation. Accurate patient’s selection and intraoperative preventive measures can reduce this eventuality.Electronic supplementary materialThe online version of this article (10.1186/s13256-018-1785-x) contains supplementary material, which is available to authorized users.

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Considerations for Optimal Device Selection in Transcatheter Aortic Valve Replacement

2020

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Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement

Abstract: DCO following TAVR is a rare phenomenon that is associated with a high in-hospital mortality rate. Clinicians should be aware that coronary obstruction can occur after the original TAVR procedure and have a low threshold for performing coronary angiography when clinically suspected.

Cited by 174 publications

References 23 publications

Severe structural deterioration of small aortic bioprostheses treated with valve-in-valve transcatheter aortic valve implantation

Severe structural deterioration of small aortic bioprostheses treated with valve-in-valve transcatheter aortic valve implantation

Sudden death after valve-in-valve procedure due to delayed coronary obstruction: a case report

Considerations for Optimal Device Selection in Transcatheter Aortic Valve Replacement

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