Abstract 15558: Clinical Impact of Coronary Protection During Transcatheter Aortic Valve Replacement: First Reported Series of 20 Patients
Background: Coronary protection with a guidewire, coronary balloon or stent positioned in the coronary artery is a pre-emptive technique to manage coronary obstruction during transcatheter aortic valve replacement (TAVR). Reported clinical experience with this technique is limited, merely in the form of case reports. We hereby describe the largest single center experience of left main (LM) coronary protection during TAVR (Table).
Methods & Results: Of 636 consecutive patients undergoing TAVR from 9/2012 [[Unable to Display Character: –]] 1/2014, LM coronary protection was used in 20 patients deemed to be at increased risk of LM compromise. Indications for LM protection included valve-in-valve in 7 (35%) patients, low LM in 13 (65%) patients (average CT distance between LM ostium and aortic annulus: 7.9 mm; range 1.1-11.6 mm) and pre-TAVR significant LM stenosis in 4 (20%) patients. Coronary guidewire was used in all cases; angioplasty balloon was used in 3 cases and coronary stent in 8. LM compromise occurred in 5 out of 20 cases, only 1 of them was symptomatic and the others were found during selective LM injections following valve deployment. These patients underwent unplanned LM stenting to treat de-novo LM compromise noted after valve deployment. One patient underwent planned balloon inflation in a previously placed LM ostial stent and 4 patients with pre-TAVR LM stenosis underwent planned LM stenting following valve deployment; all resulting in TIMI 3 flow without any complication. Device success was 100%; there were 3 cases of in-hospital major complications without evidence of LM compromise (1 case of atrial fibrillation and hypotension few days after TAVR, 1 prolonged hospitalization secondary to pneumonia and 1 delayed extubation in a patient with COPD). There was no in-hospital mortality.
Conclusions: The coronary protection technique can prevent the serious complication of coronary obstruction after TAVR and should be considered in all patients deemed to be at increased risk of LM compromise.
Author Disclosures: Y. Abramowitz: None. T. Chakravarty: None. H. Jilaihawi: Consultant/Advisory Board; Modest; Edwards Lifesciences Corporation, St. Jude Medical, Venus MedTech. M. Nakamura: None. W. Cheng: None. M. Kashif: None. N. Takahashi: None. J. Castellanos: None. A. Dhoble: None. N. Doctor: None. M. Gheorghiu: None. R.R. Makkar: Research Grant; Modest; Edwards Lifesciences Corporation, St. Jude Medical. Consultant/Advisory Board; Modest; Abbott Vascular, Cordis, Medtronic.
- © 2014 by American Heart Association, Inc.