Author + information
- Received October 2, 2019
- Revision received November 12, 2019
- Accepted November 19, 2019
- Published online March 16, 2020.
- Tullio Palmerini, MDa,∗ (, )
- Tarun Chakravarty, MDb,
- Francesco Saia, MDa,
- Antonio G. Bruno, MDa,
- Maria-Letizia Bacchi-Reggiani, MStata,
- Cinzia Marrozzini, MDa,
- Chinar Patelb,
- Vivek Patel, MDb,
- Luca Testa, MDc,
- Francesco Bedogni, MDc,
- Marco Ancona, MDd,
- Matteo Montorfano, MDd,
- Alaide Chieffo, MDd,
- Paolo Olivares, MDe,
- Antonio L. Bartorelli, MDe,
- Angelo Buscaglia, MDf,
- Italo Porto, MDf,
- Georg Nickenig, MDg,
- Eberhard Grube, MDg,
- Jan-Malte Sinning, MDg,
- Marco De Carlo, MDh,
- Anna Sonia Petronio, MDh,
- Marco Barbanti, MDi,
- Corrado Tamburino, MDi,
- Alessandro Iadanza, MDj,
- Francesco Burzotta, MDk,
- Carlo Trani, MDk,
- Chiara Fraccaro, MDl,
- Giuseppe Tarantini, MDl,
- Tiziana C. Aranzulla, MDm,
- Mauro De Benedictis, MDm,
- Paolo Pagnotta, MDn,
- Giulio G. Stefanini, MDn,
- Mizuki Miura, MDo,
- Maurizio Taramasso, MDo,
- Jee-Hoon Kang, MDp,
- Hyo-Soo Kim, MDp,
- Pablo Codner, MDq,
- Ran Kornowski, MDq,
- Francesco Pelliccia, MDr,
- Luigi Vignali, MDs,
- Nevio Taglieri, MDa,
- Gabriele Ghetti, MDa,
- Alessandro Leone, MDa,
- Nazzareno Galiè, MDa and
- Raj Makkar, MDb
- aPolo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
- bCedars-Sinai Medical Center, Los Angeles, California
- cCoronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
- dInterventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- eCentro Cardiologico Monzino, University of Milan, Milan, Italy
- fUniversity of Genova, Cardiovascular Unit, Department of Internal Medicine and Specialties and IRCCS Ospedale Policlinico San Martino, Genova, Italy
- gDepartment of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
- hAzienda Ospedaliero–Universitaria Pisana, Pisa, Italy
- iDivision of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
- jAzienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
- kInstitute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- lDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
- mInterventional Cardiology, Mauriziano Hospital, Torino, Italy
- nCardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
- oHeart Valve Clinic, University Hospital of Zürich, Zürich, Switzerland
- pDepartment of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
- qRabin Medical Center, Petah Tikva, Israel
- rDepartment of Cardiovascular Sciences, La Sapienza University, Rome, Italy
- sUO Cardiologia, Azienda Ospedaliero–Universitaria di Parma, Parma, Italy
- ↵∗Address for correspondence:
Dr. Tullio Palmerini, Polo Cardio-Toraco-Vascolare, Policlinico S. Orsola, Via Massarenti 9, 40138 Bologna, Italy.
Objectives The aim of this study was to investigate the safety and efficacy of coronary protection by preventive coronary wiring and stenting across the coronary ostia in patients at high risk for coronary obstruction after transcatheter aortic valve replacement (TAVR).
Background Coronary obstruction following TAVR is a life-threatening complication with high procedural and short-term mortality.
Methods Data were collected retrospectively from a multicenter international registry between April 2011 and February 2019.
Results Among 236 patients undergoing coronary protection with preventive coronary wiring, 143 had eventually stents implanted across the coronary ostia after valve deployment. At 3-year follow-up, rates of cardiac death were 7.8% in patients receiving stents and 15.7% in those not receiving stents (adjusted hazard ratio: 0.42; 95% confidence interval: 0.14 to 1.28; p = 0.13). There were 2 definite stent thromboses (0.9%) in patients receiving stents, both occurring after TAVR in “valve-in-valve” procedures. In patients not receiving stents, there were 4 delayed coronary occlusions (DCOs) (4.3%), occurring from 5 min to 6 h after wire removal. Three cases occurred in valve-in-valve procedures and 1 in a native aortic valve procedure. Distance between the virtual transcatheter valve and the protected coronary ostia <4 mm was present in 75.0% of patients with DCO compared with 30.4% of patients without DCO (p = 0.19).
Conclusions In patients undergoing TAVR at high risk for coronary obstruction, preventive stent implantation across the coronary ostia is associated with good mid-term survival rates and low rates of stent thrombosis. Patients undergoing coronary protection with wire only have a considerable risk for DCO.
Dr. Palmerini has received personal fees from Abbott and Edwards Lifesciences. Dr. Miura is a consultant for Japan Lifeline. Dr. Stefanini has received a research grant (to the institution) from Boston Scientific; and has received speaking and consulting fees from B. Braun, Biosensors, Boston Scientific, and GADA. Dr. Pagnotta is a proctor for Cardia, Symetis, and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 2, 2019.
- Revision received November 12, 2019.
- Accepted November 19, 2019.
- 2020 American College of Cardiology Foundation
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