The International Chimney Registry was an observational study aimed at assessing the use of chimney stenting during TAVR either to predict or treat coronary obstruction. Its main purpose was to report mortality and stent failure at long term, which remained unknown.
Primary end point was long term mortality, while secondary end point was stent failure. This was a multicenter study including patients from 35 centers distributed along three continents. Patients with all kinds of stents or valves participated, in contexts of native aortic stenosis or valve-in-valve procedures, and with traditional or orthotropic chimney stenting.
Participant mean age was 80.9 years. 30.7% of the total procedures were done in native valves, 64.6% were TAV-in-SAV, and 4.7% TAV-in-TAV. Most cases (72.5%), received the classical chimney technique with a stent positioned as protection.
Patients with established coronary artery obstruction presented significantly more adverse events, mainly death and cardiogenic shock, vs. those treated with coronary obstruction prevention strategies.
The absence of coronary protection was significantly associated with a combined end point of hospital mortality, acute myocardial infarction and cardiogenic shock (OR 8.36; CI95% 3.84-18.18; p≤0.001).
Among mortality predictors at 30 days, the most significant were the presence of established CAD (OR 10.02; p≤0.001) and lack of coronary protection (OR 7.11; p=0.002). On the other hand, long term mortality predictors were stage ≥2 kidney failure (OR 2.32; p=0.039) and access other than femoral. There were no predictors of stent failure.
Read also: TRISCEND II: Transcatheter Replacement vs. Medical Treatment for Tricuspid Regurgitation.
Chimney stent failure was low (4%), with no significant differences in events according to coronary prevention strategy. At midterm follow-up, global mortality reached 22.4%.
Presented by Paolo Alberto del Sole at Top Late-Breaking Trials, PCR London Valves, November 24, 2024, London, GB.
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