Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement

Richard J Jabbour; Akihito Tanaka; Ariel Finkelstein; Michael Mack; Corrado Tamburino; Nicolas Van Mieghem; Ole de Backer; Luca Testa; Pamela Gatto; Paola Purita; Zouhair Rahhab; Verena Veulemans; Anja Stundl; Marco Barbanti; Roberto Nerla; Jan Malte Sinning; Danny Dvir; Giuseppe Tarantini; Molly Szerlip; Werner Scholtz; Smita Scholtz; Didier Tchetche; Fausto Castriota; Christian Butter; Lars Søndergaard; Mohamed Abdel-Wahab; Horst Sievert; Ottavio Alfieri; John Webb; Josep Rodés-Cabau; Antonio Colombo; Azeem Latib

doi:10.1016/j.jacc.2018.01.066

Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement

Richard J Jabbour, Akihito Tanaka, Ariel Finkelstein, Michael Mack, Corrado Tamburino, Nicolas Van Mieghem, Ole de Backer, Luca Testa, Pamela Gatto, Paola Purita, Zouhair Rahhab, Verena Veulemans, Anja Stundl, Marco Barbanti, Roberto Nerla, Jan Malte Sinning, Danny Dvir, Giuseppe Tarantini, Molly Szerlip, Werner ScholtzSmita Scholtz, Didier Tchetche, Fausto Castriota, Christian Butter, Lars Søndergaard, Mohamed Abdel-Wahab, Horst Sievert, Ottavio Alfieri, John Webb, Josep Rodés-Cabau, Antonio Colombo, Azeem Latib

Department of Clinical Medicine

78 Citations (Scopus)

Abstract

Background: Delayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR). Objectives: The aim of this study was to describe the incidence and pathophysiological features of DCO after TAVR, obtained from a large international multicenter registry. Methods: Data were retrospectively collected from an international multicenter registry consisting of 18 centers between November 2005 and December 2016. Results: During the study period, 38 DCO (incidence 0.22%) cases were identified from a total of 17,092 TAVR procedures. DCO occurred more commonly after valve-in-valve procedures (0.89% vs. 0.18%; p < 0.001) and if self-expandable valves were used during the index procedure (0.36% vs. 0.11% balloon expandable; p < 0.01). DCO was most likely to occur ≤24 h after the TAVR procedure (47.4%; n = 18); 6 (15.8%) cases occurred between 24 h and ≤7 days, with the remaining 14 (36.8%) at ≥60 days. The most frequent presentation was cardiac arrest (31.6%; n = 12), followed by ST-segment elevation myocardial infarction (23.7%; n = 9). The left coronary artery was obstructed in most cases (92.1%; n = 35). Percutaneous coronary intervention was attempted in the majority of cases (74.3% left main; 60% right coronary), and stent implantation was successful in 68.8%. The overall in-hospital death rate was 50% (n = 19), and was higher if DCO occurred ≤7 days from the index procedure (62.5% vs. 28.6%; p = 0.09). Conclusions: DCO following TAVR is a rare phenomenon that is associated with a high in-hospital mortality rate. Clinicians should be aware that coronary obstruction can occur after the original TAVR procedure and have a low threshold for performing coronary angiography when clinically suspected.

Original language	English
Journal	Journal of the American College of Cardiology
Volume	71
Issue number	14
Pages (from-to)	1513-1524
Number of pages	12
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2018.01.066
Publication status	Published - 10 Apr 2018

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10.1016/j.jacc.2018.01.066

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Jabbour, R. J., Tanaka, A., Finkelstein, A., Mack, M., Tamburino, C., Van Mieghem, N., de Backer, O., Testa, L., Gatto, P., Purita, P., Rahhab, Z., Veulemans, V., Stundl, A., Barbanti, M., Nerla, R., Sinning, J. M., Dvir, D., Tarantini, G., Szerlip, M., ... Latib, A. (2018). Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology, 71(14), 1513-1524. https://doi.org/10.1016/j.jacc.2018.01.066

Jabbour, RJ, Tanaka, A, Finkelstein, A, Mack, M, Tamburino, C, Van Mieghem, N, de Backer, O, Testa, L, Gatto, P, Purita, P, Rahhab, Z, Veulemans, V, Stundl, A, Barbanti, M, Nerla, R, Sinning, JM, Dvir, D, Tarantini, G, Szerlip, M, Scholtz, W, Scholtz, S, Tchetche, D, Castriota, F, Butter, C, Søndergaard, L, Abdel-Wahab, M, Sievert, H, Alfieri, O, Webb, J, Rodés-Cabau, J, Colombo, A & Latib, A 2018, 'Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement', Journal of the American College of Cardiology, vol. 71, no. 14, pp. 1513-1524. https://doi.org/10.1016/j.jacc.2018.01.066

@article{dcd31133dadf4a46ba17fd77f103f908,

title = "Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement",

abstract = "Background: Delayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR). Objectives: The aim of this study was to describe the incidence and pathophysiological features of DCO after TAVR, obtained from a large international multicenter registry. Methods: Data were retrospectively collected from an international multicenter registry consisting of 18 centers between November 2005 and December 2016. Results: During the study period, 38 DCO (incidence 0.22%) cases were identified from a total of 17,092 TAVR procedures. DCO occurred more commonly after valve-in-valve procedures (0.89% vs. 0.18%; p < 0.001) and if self-expandable valves were used during the index procedure (0.36% vs. 0.11% balloon expandable; p < 0.01). DCO was most likely to occur ≤24 h after the TAVR procedure (47.4%; n = 18); 6 (15.8%) cases occurred between 24 h and ≤7 days, with the remaining 14 (36.8%) at ≥60 days. The most frequent presentation was cardiac arrest (31.6%; n = 12), followed by ST-segment elevation myocardial infarction (23.7%; n = 9). The left coronary artery was obstructed in most cases (92.1%; n = 35). Percutaneous coronary intervention was attempted in the majority of cases (74.3% left main; 60% right coronary), and stent implantation was successful in 68.8%. The overall in-hospital death rate was 50% (n = 19), and was higher if DCO occurred ≤7 days from the index procedure (62.5% vs. 28.6%; p = 0.09). Conclusions: DCO following TAVR is a rare phenomenon that is associated with a high in-hospital mortality rate. Clinicians should be aware that coronary obstruction can occur after the original TAVR procedure and have a low threshold for performing coronary angiography when clinically suspected.",

author = "Jabbour, {Richard J} and Akihito Tanaka and Ariel Finkelstein and Michael Mack and Corrado Tamburino and {Van Mieghem}, Nicolas and {de Backer}, Ole and Luca Testa and Pamela Gatto and Paola Purita and Zouhair Rahhab and Verena Veulemans and Anja Stundl and Marco Barbanti and Roberto Nerla and Sinning, {Jan Malte} and Danny Dvir and Giuseppe Tarantini and Molly Szerlip and Werner Scholtz and Smita Scholtz and Didier Tchetche and Fausto Castriota and Christian Butter and Lars S{\o}ndergaard and Mohamed Abdel-Wahab and Horst Sievert and Ottavio Alfieri and John Webb and Josep Rod{\'e}s-Cabau and Antonio Colombo and Azeem Latib",

year = "2018",

month = apr,

day = "10",

doi = "10.1016/j.jacc.2018.01.066",

language = "English",

volume = "71",

pages = "1513--1524",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

number = "14",

}

TY - JOUR

T1 - Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement

AU - Jabbour, Richard J

AU - Tanaka, Akihito

AU - Finkelstein, Ariel

AU - Mack, Michael

AU - Tamburino, Corrado

AU - Van Mieghem, Nicolas

AU - de Backer, Ole

AU - Testa, Luca

AU - Gatto, Pamela

AU - Purita, Paola

AU - Rahhab, Zouhair

AU - Veulemans, Verena

AU - Stundl, Anja

AU - Barbanti, Marco

AU - Nerla, Roberto

AU - Sinning, Jan Malte

AU - Dvir, Danny

AU - Tarantini, Giuseppe

AU - Szerlip, Molly

AU - Scholtz, Werner

AU - Scholtz, Smita

AU - Tchetche, Didier

AU - Castriota, Fausto

AU - Butter, Christian

AU - Søndergaard, Lars

AU - Abdel-Wahab, Mohamed

AU - Sievert, Horst

AU - Alfieri, Ottavio

AU - Webb, John

AU - Rodés-Cabau, Josep

AU - Colombo, Antonio

AU - Latib, Azeem

PY - 2018/4/10

Y1 - 2018/4/10

N2 - Background: Delayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR). Objectives: The aim of this study was to describe the incidence and pathophysiological features of DCO after TAVR, obtained from a large international multicenter registry. Methods: Data were retrospectively collected from an international multicenter registry consisting of 18 centers between November 2005 and December 2016. Results: During the study period, 38 DCO (incidence 0.22%) cases were identified from a total of 17,092 TAVR procedures. DCO occurred more commonly after valve-in-valve procedures (0.89% vs. 0.18%; p < 0.001) and if self-expandable valves were used during the index procedure (0.36% vs. 0.11% balloon expandable; p < 0.01). DCO was most likely to occur ≤24 h after the TAVR procedure (47.4%; n = 18); 6 (15.8%) cases occurred between 24 h and ≤7 days, with the remaining 14 (36.8%) at ≥60 days. The most frequent presentation was cardiac arrest (31.6%; n = 12), followed by ST-segment elevation myocardial infarction (23.7%; n = 9). The left coronary artery was obstructed in most cases (92.1%; n = 35). Percutaneous coronary intervention was attempted in the majority of cases (74.3% left main; 60% right coronary), and stent implantation was successful in 68.8%. The overall in-hospital death rate was 50% (n = 19), and was higher if DCO occurred ≤7 days from the index procedure (62.5% vs. 28.6%; p = 0.09). Conclusions: DCO following TAVR is a rare phenomenon that is associated with a high in-hospital mortality rate. Clinicians should be aware that coronary obstruction can occur after the original TAVR procedure and have a low threshold for performing coronary angiography when clinically suspected.

AB - Background: Delayed coronary obstruction (DCO) is an uncommon and barely reported complication following transcatheter aortic valve replacement (TAVR). Objectives: The aim of this study was to describe the incidence and pathophysiological features of DCO after TAVR, obtained from a large international multicenter registry. Methods: Data were retrospectively collected from an international multicenter registry consisting of 18 centers between November 2005 and December 2016. Results: During the study period, 38 DCO (incidence 0.22%) cases were identified from a total of 17,092 TAVR procedures. DCO occurred more commonly after valve-in-valve procedures (0.89% vs. 0.18%; p < 0.001) and if self-expandable valves were used during the index procedure (0.36% vs. 0.11% balloon expandable; p < 0.01). DCO was most likely to occur ≤24 h after the TAVR procedure (47.4%; n = 18); 6 (15.8%) cases occurred between 24 h and ≤7 days, with the remaining 14 (36.8%) at ≥60 days. The most frequent presentation was cardiac arrest (31.6%; n = 12), followed by ST-segment elevation myocardial infarction (23.7%; n = 9). The left coronary artery was obstructed in most cases (92.1%; n = 35). Percutaneous coronary intervention was attempted in the majority of cases (74.3% left main; 60% right coronary), and stent implantation was successful in 68.8%. The overall in-hospital death rate was 50% (n = 19), and was higher if DCO occurred ≤7 days from the index procedure (62.5% vs. 28.6%; p = 0.09). Conclusions: DCO following TAVR is a rare phenomenon that is associated with a high in-hospital mortality rate. Clinicians should be aware that coronary obstruction can occur after the original TAVR procedure and have a low threshold for performing coronary angiography when clinically suspected.

U2 - 10.1016/j.jacc.2018.01.066

DO - 10.1016/j.jacc.2018.01.066

M3 - Journal article

C2 - 29622157

SN - 0735-1097

VL - 71

SP - 1513

EP - 1524

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 14

ER -

Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement

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