Transcatheter Aortic Valve Replacement in Patients at High Risk of Coronary Obstruction

Yousif Ahmad; Luke Oakley; Sunghan Yoon; Danon Kaewkes; Tarun Chakravarty; Chinar Patel; Tullio Palmerini; Antonio G. Bruno; Francesco Saia; Luca Testa; Francesco Bedogni; Alaide Chieffo; Matteo Montorfano; Antonio L. Bartorelli; Italo Porto; Eberhard Grube; Georg Nickenig; Jan Malte Sinning; Marco De Carlo; Anna Sonia Petronio; Marco Barbanti; Corrado Tamburino; Alessandro Iadanza; Francesco Burzotta; Carlo Trani; Chiara Fraccaro; Giuseppe Tarantini; Tiziana C. Aranzulla; Giuseppe Musumeci; Giulio G. Stefanini; Maurizio Taramasso; Hyo Soo Kim; Pablo Codner; Ran Kornowski; Francesco Pelliccia; Luigi Vignali; Raj R. Makkar

doi:10.1016/j.jscai.2022.100347

Transcatheter Aortic Valve Replacement in Patients at High Risk of Coronary Obstruction

Yousif Ahmad
, Luke Oakley
, Sunghan Yoon
, Danon Kaewkes
, Tarun Chakravarty
, Chinar Patel
, Tullio Palmerini
, Antonio G. Bruno
, Francesco Saia
, Luca Testa
, Francesco Bedogni
, Alaide Chieffo
, Matteo Montorfano
, Antonio L. Bartorelli
, Italo Porto
, Eberhard Grube
, Georg Nickenig
, Jan Malte Sinning
, Marco De Carlo
, Anna Sonia Petronio

Marco Barbanti, Corrado Tamburino, Alessandro Iadanza, Francesco Burzotta, Carlo Trani, Chiara Fraccaro, Giuseppe Tarantini, Tiziana C. Aranzulla, Giuseppe Musumeci, Giulio G. Stefanini, Maurizio Taramasso, Hyo Soo Kim, Pablo Codner, Ran Kornowski, Francesco Pelliccia, Luigi Vignali, Raj R. Makkar

School of Medicine

Yale University
Cedars-Sinai Medical Center
University of Bologna
IRCCS Policlinico San Donato
San Raffaele Scientific Institute
University of Milan
IRCCS Ospedale Policlinico San Martino
University of Bonn
Azienda Ospedaliero Universitaria Pisana
University of Catania
Azienda Ospedaliera Universitaria Senese
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
University of Padua
Ospedale Mauriziano Umberto I
IRCCS Istituto Clinico Humanitas - Rozzano (Milano)
University of Zurich
Seoul National University
Rabin Medical Center Israel
University of Rome La Sapienza
University of Parma

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Background: Coronary obstruction following transcatheter aortic valve replacement (TAVR) is a life-threatening complication. For patients at elevated risk, it is not known how valve choice is influenced by clinical and anatomic factors and how outcomes differ between valve platforms. For patients at high risk of coronary obstruction, we sought to describe the anatomical and clinical characteristics of patients treated with both balloon-expandable (BE) and self-expanding (SE) valves. Methods: This was a multicenter international registry of patients undergoing TAVR who are considered to be at high risk of coronary obstruction and receiving pre-emptive coronary protection. Results: A total of 236 patients were included. Patients receiving SE valves were more likely to undergo valve-in-valve procedures and also had smaller sinuses of Valsalva and valve-to-coronary distance. Three-year cardiac mortality was 21.6% with SE vs 3.7% with BE valves. This was primarily driven by increased rates of definite or probable coronary occlusion, which occurred in 12.1% of patients with SE valves vs 2.1% in patients with BE valves. Conclusions: In patients undergoing TAVR with coronary protection, those treated with SE valves had increased rates of clinical and anatomic features that increase the risk of coronary obstruction. These include an increased frequency of valve-in-valve procedures, smaller sinuses of Valsalva, and smaller valve-to-coronary distances. These patients were observed to have increased cardiac mortality compared with patients treated with BE valves, but this is likely due to their higher risk clinical and anatomic phenotypes rather than as a function of the valve type itself.

Original language	English
Article number	100347
Journal	Journal of the Society for Cardiovascular Angiography and Interventions
Volume	1
Issue number	4
DOIs	https://doi.org/10.1016/j.jscai.2022.100347
State	Published - 1 Jul 2022

Keywords

Aortic stenosis
coronary obstruction
transcatheter aortic valve replacement

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10.1016/j.jscai.2022.100347

Cite this

Ahmad, Y., Oakley, L., Yoon, S., Kaewkes, D., Chakravarty, T., Patel, C., Palmerini, T., Bruno, A. G., Saia, F., Testa, L., Bedogni, F., Chieffo, A., Montorfano, M., Bartorelli, A. L., Porto, I., Grube, E., Nickenig, G., Sinning, J. M., De Carlo, M., ... Makkar, R. R. (2022). Transcatheter Aortic Valve Replacement in Patients at High Risk of Coronary Obstruction. Journal of the Society for Cardiovascular Angiography and Interventions, 1(4), Article 100347. https://doi.org/10.1016/j.jscai.2022.100347

@article{32f8b775ad3c40a38cb5152fde796d10,

title = "Transcatheter Aortic Valve Replacement in Patients at High Risk of Coronary Obstruction",

abstract = "Background: Coronary obstruction following transcatheter aortic valve replacement (TAVR) is a life-threatening complication. For patients at elevated risk, it is not known how valve choice is influenced by clinical and anatomic factors and how outcomes differ between valve platforms. For patients at high risk of coronary obstruction, we sought to describe the anatomical and clinical characteristics of patients treated with both balloon-expandable (BE) and self-expanding (SE) valves. Methods: This was a multicenter international registry of patients undergoing TAVR who are considered to be at high risk of coronary obstruction and receiving pre-emptive coronary protection. Results: A total of 236 patients were included. Patients receiving SE valves were more likely to undergo valve-in-valve procedures and also had smaller sinuses of Valsalva and valve-to-coronary distance. Three-year cardiac mortality was 21.6\% with SE vs 3.7\% with BE valves. This was primarily driven by increased rates of definite or probable coronary occlusion, which occurred in 12.1\% of patients with SE valves vs 2.1\% in patients with BE valves. Conclusions: In patients undergoing TAVR with coronary protection, those treated with SE valves had increased rates of clinical and anatomic features that increase the risk of coronary obstruction. These include an increased frequency of valve-in-valve procedures, smaller sinuses of Valsalva, and smaller valve-to-coronary distances. These patients were observed to have increased cardiac mortality compared with patients treated with BE valves, but this is likely due to their higher risk clinical and anatomic phenotypes rather than as a function of the valve type itself.",

keywords = "Aortic stenosis, coronary obstruction, transcatheter aortic valve replacement",

author = "Yousif Ahmad and Luke Oakley and Sunghan Yoon and Danon Kaewkes and Tarun Chakravarty and Chinar Patel and Tullio Palmerini and Bruno, \{Antonio G.\} and Francesco Saia and Luca Testa and Francesco Bedogni and Alaide Chieffo and Matteo Montorfano and Bartorelli, \{Antonio L.\} and Italo Porto and Eberhard Grube and Georg Nickenig and Sinning, \{Jan Malte\} and \{De Carlo\}, Marco and Petronio, \{Anna Sonia\} and Marco Barbanti and Corrado Tamburino and Alessandro Iadanza and Francesco Burzotta and Carlo Trani and Chiara Fraccaro and Giuseppe Tarantini and Aranzulla, \{Tiziana C.\} and Giuseppe Musumeci and Stefanini, \{Giulio G.\} and Maurizio Taramasso and Kim, \{Hyo Soo\} and Pablo Codner and Ran Kornowski and Francesco Pelliccia and Luigi Vignali and Makkar, \{Raj R.\}",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = jul,

day = "1",

doi = "10.1016/j.jscai.2022.100347",

language = "English",

volume = "1",

journal = "Journal of the Society for Cardiovascular Angiography and Interventions",

issn = "2772-9303",

publisher = "Elsevier B.V.",

number = "4",

}

Ahmad, Y, Oakley, L, Yoon, S, Kaewkes, D, Chakravarty, T, Patel, C, Palmerini, T, Bruno, AG, Saia, F, Testa, L, Bedogni, F, Chieffo, A, Montorfano, M, Bartorelli, AL, Porto, I, Grube, E, Nickenig, G, Sinning, JM, De Carlo, M, Petronio, AS, Barbanti, M, Tamburino, C, Iadanza, A, Burzotta, F, Trani, C, Fraccaro, C, Tarantini, G, Aranzulla, TC, Musumeci, G, Stefanini, GG, Taramasso, M, Kim, HS, Codner, P, Kornowski, R, Pelliccia, F, Vignali, L & Makkar, RR 2022, 'Transcatheter Aortic Valve Replacement in Patients at High Risk of Coronary Obstruction', Journal of the Society for Cardiovascular Angiography and Interventions, vol. 1, no. 4, 100347. https://doi.org/10.1016/j.jscai.2022.100347

TY - JOUR

T1 - Transcatheter Aortic Valve Replacement in Patients at High Risk of Coronary Obstruction

AU - Ahmad, Yousif

AU - Oakley, Luke

AU - Yoon, Sunghan

AU - Kaewkes, Danon

AU - Chakravarty, Tarun

AU - Patel, Chinar

AU - Palmerini, Tullio

AU - Bruno, Antonio G.

AU - Saia, Francesco

AU - Testa, Luca

AU - Bedogni, Francesco

AU - Chieffo, Alaide

AU - Montorfano, Matteo

AU - Bartorelli, Antonio L.

AU - Porto, Italo

AU - Grube, Eberhard

AU - Nickenig, Georg

AU - Sinning, Jan Malte

AU - De Carlo, Marco

AU - Petronio, Anna Sonia

AU - Barbanti, Marco

AU - Tamburino, Corrado

AU - Iadanza, Alessandro

AU - Burzotta, Francesco

AU - Trani, Carlo

AU - Fraccaro, Chiara

AU - Tarantini, Giuseppe

AU - Aranzulla, Tiziana C.

AU - Musumeci, Giuseppe

AU - Stefanini, Giulio G.

AU - Taramasso, Maurizio

AU - Kim, Hyo Soo

AU - Codner, Pablo

AU - Kornowski, Ran

AU - Pelliccia, Francesco

AU - Vignali, Luigi

AU - Makkar, Raj R.

PY - 2022/7/1

Y1 - 2022/7/1

N2 - Background: Coronary obstruction following transcatheter aortic valve replacement (TAVR) is a life-threatening complication. For patients at elevated risk, it is not known how valve choice is influenced by clinical and anatomic factors and how outcomes differ between valve platforms. For patients at high risk of coronary obstruction, we sought to describe the anatomical and clinical characteristics of patients treated with both balloon-expandable (BE) and self-expanding (SE) valves. Methods: This was a multicenter international registry of patients undergoing TAVR who are considered to be at high risk of coronary obstruction and receiving pre-emptive coronary protection. Results: A total of 236 patients were included. Patients receiving SE valves were more likely to undergo valve-in-valve procedures and also had smaller sinuses of Valsalva and valve-to-coronary distance. Three-year cardiac mortality was 21.6% with SE vs 3.7% with BE valves. This was primarily driven by increased rates of definite or probable coronary occlusion, which occurred in 12.1% of patients with SE valves vs 2.1% in patients with BE valves. Conclusions: In patients undergoing TAVR with coronary protection, those treated with SE valves had increased rates of clinical and anatomic features that increase the risk of coronary obstruction. These include an increased frequency of valve-in-valve procedures, smaller sinuses of Valsalva, and smaller valve-to-coronary distances. These patients were observed to have increased cardiac mortality compared with patients treated with BE valves, but this is likely due to their higher risk clinical and anatomic phenotypes rather than as a function of the valve type itself.

AB - Background: Coronary obstruction following transcatheter aortic valve replacement (TAVR) is a life-threatening complication. For patients at elevated risk, it is not known how valve choice is influenced by clinical and anatomic factors and how outcomes differ between valve platforms. For patients at high risk of coronary obstruction, we sought to describe the anatomical and clinical characteristics of patients treated with both balloon-expandable (BE) and self-expanding (SE) valves. Methods: This was a multicenter international registry of patients undergoing TAVR who are considered to be at high risk of coronary obstruction and receiving pre-emptive coronary protection. Results: A total of 236 patients were included. Patients receiving SE valves were more likely to undergo valve-in-valve procedures and also had smaller sinuses of Valsalva and valve-to-coronary distance. Three-year cardiac mortality was 21.6% with SE vs 3.7% with BE valves. This was primarily driven by increased rates of definite or probable coronary occlusion, which occurred in 12.1% of patients with SE valves vs 2.1% in patients with BE valves. Conclusions: In patients undergoing TAVR with coronary protection, those treated with SE valves had increased rates of clinical and anatomic features that increase the risk of coronary obstruction. These include an increased frequency of valve-in-valve procedures, smaller sinuses of Valsalva, and smaller valve-to-coronary distances. These patients were observed to have increased cardiac mortality compared with patients treated with BE valves, but this is likely due to their higher risk clinical and anatomic phenotypes rather than as a function of the valve type itself.

KW - Aortic stenosis

KW - coronary obstruction

KW - transcatheter aortic valve replacement

UR - https://www.scopus.com/pages/publications/85161827034

U2 - 10.1016/j.jscai.2022.100347

DO - 10.1016/j.jscai.2022.100347

M3 - Article

AN - SCOPUS:85161827034

SN - 2772-9303

VL - 1

JO - Journal of the Society for Cardiovascular Angiography and Interventions

JF - Journal of the Society for Cardiovascular Angiography and Interventions

IS - 4

M1 - 100347

ER -

Transcatheter Aortic Valve Replacement in Patients at High Risk of Coronary Obstruction

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Keywords

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