Author + information
- Received November 4, 2019
- Revision received January 21, 2020
- Accepted January 23, 2020
- Published online March 16, 2020.
- Federico Mercanti, MDa,
- Liesbeth Rosseel, MDa,
- Antoinette Neylon, MDa,
- Rodrigo Bagur, MDb,
- Jan-Malte Sinning, MDc,
- Georg Nickenig, MDc,
- Eberhard Grube, MDc,
- David Hildick-Smith, MDd,
- Davide Tavano, MDe,
- Alexander Wolf, MDf,
- Giuseppe Colonna, MDg,
- Azeem Latib, MDh,
- Satoru Mitomo, MDh,
- Anna Sonia Petronio, MDi,
- Marco Angelillis, MDi,
- Didier Tchétché, MDj,
- Chiara De Biase, MDj,
- Marianna Adamo, MDk,
- Mohammed Nejjari, MDl,
- Franck Digne, MDl,
- Ulrich Schäfer, MDm,
- Nicolas Amabile, MDn,
- Guy Achkouty, MDn,
- Raj R. Makkar, MDo,
- Sung-Han Yoon, MDo,
- Ariel Finkelstein, MDp,
- Danny Dvir, MDq,
- Tara Jones, MDq,
- Bernard Chevalier, MDr,
- Thierry Lefevre, MDr,
- Nicolo Piazza, MD, PhDs and
- Darren Mylotte, MD, PhDa,t,∗ ()
- aUniversity Hospital and SAOLTA University Health Care Group, Galway, Ireland
- bDivision of Cardiology, London Health Sciences Centre, School of Medicine & Dentistry, Western University, London, Ontario, Canada
- cHeart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
- dSussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
- eIRCCS Multimedica, Sesto San Giovanni, Milan, Italy
- fDepartment of Interventional Cardiology, Elisabeth Hospital Essen, Essen, Germany
- gDepartment of Cardiology, Vito Fazzi Hospital, Lecce, Italy
- hUnit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
- iCardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- jClinique Pasteur, Groupe Cardiovasculaire Interventionel, Toulouse, France
- kCardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
- lHemodynamic Department, Centre Cardiologique du Nord, Saint Denis, France
- mDepartment of General and Interventional Cardiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- nDepartment of Cardiology, Institut Mutualiste Montsouris, Paris, France
- oSmidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
- pTel Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel
- qDivision of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington
- rInstitut Cardiovasculaire de Paris, Massy, France
- sMcGill University Health Centre, Montreal, Quebec, Canada
- tNational University of Ireland, Galway, Ireland
- ↵∗Address for correspondence:
Dr. Darren Mylotte, University Hospital and SAOLTA, University Health Care Group, Newcastle Road, H91 YR71 Galway, Ireland.
Objectives The aim of this study was to determine the safety and efficacy of chimney stenting, a bailout technique to treat coronary artery occlusion (CAO).
Background CAO during transcatheter aortic valve replacement (TAVR) is a rare but often fatal complication.
Methods In the international Chimney Registry, patient and procedural characteristics and data on outcomes are retrospectively collected from patients who underwent chimney stenting during TAVR.
Results To date, 16 centers have contributed 60 cases among 12,800 TAVR procedures (0.5%). Chimney stenting was performed for 2 reasons: 1) due to the development of an established CAO (n = 25 [41.6%]); or 2) due to an impending CAO (n = 35 [58.3%]). The majority of cases (92.9%) had 1 or more classical risk factors for CAO. Upfront coronary protection was performed in 44 patients (73.3%). Procedural and in-hospital mortality occurred in 1 and 2 patients, respectively. Myocardial infarction (52.0% vs. 0.0%; p < 0.01), cardiogenic shock (52.0% vs. 2.9%; p < 0.01), and resuscitation (44.0% vs. 2.9%; p < 0.01) all occurred more frequently in patients with established CAO compared with those with impending CAO. The absence of upfront coronary protection was the sole independent risk factor for the combined endpoint of death, cardiogenic shock, or myocardial infarction. During a median follow-up time of 612 days (interquartile range: 405 to 842 days), 2 cases of stent failure were reported (1 in-stent restenosis, 1 possible late stent thrombosis) after 157 and 374 days.
Conclusions Chimney stenting appears to be an acceptable bailout technique for CAO, with higher event rates among those with established CAO and among those without upfront coronary protection.
- chimney stenting
- coronary artery obstruction
- coronary protection
- myocardial infarction
- transcatheter aortic valve replacement
Dr. De Biase has been supported by a research grant provided by the Cardiopath PhD program. Dr. Makkar received grant support and is a consultant for Cordis, Medtronic, Abbott, and Edward Lifesciences. Dr. Mylotte is a proctor and consultant for Medtronic and Microport; and is a consultant for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 4, 2019.
- Revision received January 21, 2020.
- Accepted January 23, 2020.
- 2020 American College of Cardiology Foundation
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