Original title: Predictive Factors, Management and Clinical Outcomes of Coronary obstruction Following Transcatheter Aortic Valve Implantation Insight From a Large Multicenter Registry Reference: Henrique B. Ribeiro, et; al. J Am Coll Cardiology 2013;62:1552-62
Percutaneous implantation of the aortic valve is a valid strategy in high-risk surgical patients. One of the possible complications of this procedure is the occlusion of the coronary arteries by displacing calcium during implantation.
In this multicenter registry 6688 patients were included, all received a percutaneous valve implantation, in 44 cases (0.66 %) symptomatic coronary occlusion was observed. Patients with this complication were older, women, higher EuroSCORE log, history of prior biological valve replacement and also more common balloon- expandable valves. By contrast, the history of previous myocardial revascularization surgery was a protective factor. Using CT they had a lower aortic area, smaller diameter at the sinotubular junction, and less distance between the valve and the coronary ostium (
Conclusion:
Occlusion of coronary arteries during implantation of an aortic valve (PCI) is a complication that compromises life, is more common in women, with expandable balloon valves in those who previously received biological valve. The low confinement of the Ostia and the sinuses of Valsalva physiognomies are anatomical factors associated with treatment success and also important to anticipate or prevent the occurrence of this complication.
Comment
Although coronary occlusion is rare, its presence adversely impacts directly on the immediate and short -term developments, in addition to prolonging hospitalization and the cost of the procedure. This complication is related to the anatomy of the valve and can be evaluated by CT. Proper patient selection, implant device and technological improvements of the new valves will decrease this eventuality.
Courtesy Dr Carlos Fava .
Interventional Cardiologist
Favaloro Foundation – Argentina
Dr. Carlos Fava para SOLACI.ORG
