Procedural and Mid-Term Outcomes of Coronary Protection During Transcatheter Aortic Valve Replacement in Patients at Risk of Coronary Occlusion: Insight From a Single-Centre Retrospective Analysis

• Published in: Cardiovascular revascularization medicine Vol. 27; pp. 7 - 13
• Main Authors: So, Chak-yu, Kang, Guson, Villablanca, Pedro A., Lee, James C., Frisoli, Tiberio M., Wyman, Janet F., Wang, Dee Dee, O'Neill, William W., Eng, Marvin H.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.06.2021
• Subjects: Chimney stenting; Coronary protection; Transcatheter aortic valve replacement; CT; Coronary protection; AS; VIV; Chimney stenting; VTC; CO; CP; Transcatheter aortic valve replacement; TAVR
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2020.06.032

Detailed procedural analysis and long-term data is limited for coronary protection (CP) during transcatheter aortic valve replacement (TAVR) for patients with high anatomical risk for coronary occlusion (CO). We aim to assess the procedural and mid-term outcomes of CP during TAVR. We retrospectively analyzed patients who underwent TAVR at Henry Ford Hospital, USA from January 2015 to August 2019 and identified those considered at risk of CO and underwent pre-emptive CP with or without subsequent “chimney” stenting (i.e. coronary stenting with intentional protrusion into the aorta). Procedural features, immediate and mid-term clinical outcomes were reviewed. Twenty-five out of 1166 (2.1%) patients underwent TAVR with CP, including 10 (40%) valve-in-valve procedures. Twenty-eight coronary arteries (Left: n = 11, Right: n = 11; Left + Right: n = 3) were protected. Eleven coronaries (39.3%) were electively “chimney”-stented due to angiographic evidence of coronary impingement (63.6%), tactile resistance while withdrawing stent (27.3%) and electrocardiogram change (9.1%). Twenty-four patients (24/25, 96%) had successful TAVR without CO. Procedure-related complications included stent-balloon entrapment (n = 1), stent entrapment (n = 1) and occlusive distal stent edge dissection (n = 1). After a mean follow-up of 19.1 months, there was 1 cardiac death but no target vessel re-intervention or myocardial infarction. Our study found that angiographic evidence of coronary impingement (63.6%) was the most common reason for stent deployment during TAVR with CP. The mid-term clinical outcome of CP with TAVR was favorable. •In TAVR, angiographic evidence of coronary impingement was the most common indication for “chimney” stenting•Mid-term outcome of coronary protection for patients with high anatomical risk for occlusion during TAVI is promising.•There was no difference in the survival between patients with or without final “chimney” stenting.