Predictive Factors, Management, and Clinical Outcomes of Coronary Obstruction Following Transcatheter Aortic Valve Implantation

Abstract

Symptomatic CO following TAVI was a rare but life-threatening complication that occurred more frequently in women, in patients receiving a balloon-expandable valve, and in those with a previous surgical bioprosthesis. Lower-lying coronary ostium and shallow sinus of Valsalva were associated anatomic factors, and despite successful treatment, acute and late mortality remained very high, highlighting the importance of anticipating and preventing the occurrence of this complication.

Transcatheter Aortic Valve-in-Valve Implantation for Patients With Degenerative Surgical Bioprosthetic Valves

“…46 The reported frequency of 3.5% in early reports of the global registry experience is much higher than that associated with native valve procedures, but there is a trend to improved outcomes in more recent reports. 14, 43 Left main occlusion is much more common, although right coronary obstruction may rarely occur ( Figure 4B).…”

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

“…In this regard, MDCT enables accurate assessment of the height of the coronary ostia in relation to the surgical bioprosthesis and the width of the aortic sinus. Low coronary height (<12 mm) and/or small sinus of Valsalva diameter (<30 mm) will increase the risk for coronary artery obstruction during native valve TAVR,33 and aortic VIV procedures are associated with a higher risk 29. Unfavorable anatomy identified on MDCT may prompt avoidance of a VIV procedure altogether; it may also direct the implanter to use balloon sizing, or use a risk‐minimization strategy, such as less aggressive valve oversizing and deeper valve implantation, to avoid coronary artery occlusion.…”

Transcatheter Aortic Valve Replacement: Comprehensive Review and Present Status

“…Transcatheter AVR is associated with low risk of coronary ostial obstruction (<1%) in patients with native-valve AS. 62 The risk goes up 3-to 4-fold in patients who have undergone valve-in-valve TAVR. 62 Coronary obstruction after TAVR is associated with a high mortality rate.…”

“…62 The risk goes up 3-to 4-fold in patients who have undergone valve-in-valve TAVR. 62 Coronary obstruction after TAVR is associated with a high mortality rate. The mechanism is generally speculated to be direct or near-direct contact between the bioprosthetic valve and the coronary ostium.…”