Clinical outcomes of coronary occlusion following transcatheter aortic valve replacement

A systematic review

Oluwaseun A. Akinseye, Sunil Jha, Uzoma Ibebuogu

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Background: Coronary occlusion (CO) is a rare but serious complication following transcatheter aortic valve replacement (TAVR) with limited published data. We sought to evaluate the immediate and short-term outcomes of CO complicating TAVR. Methods: Studies, including case reports, case series and original articles published from 2002 to 2016 describing CO following TAVR were identified with a systematic electronic search using the PRISMA Statement. Only studies reporting data on demographic and procedural characteristics, management and follow up outcomes were analyzed. Results: A total of 40 publications describing 96 patients (86 native, 10 bioprosthetic) were identified. Mean age was 83 ± 7 years and most (81%) were females. The mean logistic EuroSCORE and STS score was 23.5 ± 14.6% and 9.1 ± 3.2% respectively. TAVR access site was transfemoral in 73% and a balloon expandable valve was used in 78%. Among those with LCA occlusion, the mean LCA ostium height was 10.1 ± 1.8 mm while the mean RCA ostium height was 10.4 ± 2.0 mm among those with RCA occlusion. CO frequently involved the left main coronary artery (80%) and the most common mechanism was displacement of native valve leaflet (60%), and most cases occurred within 1-hour post-implantation (88%). Percutaneous coronary intervention was attempted in 82 patients and successful in 89%. Procedural death was 10.4%. CO following TAVR in native aortic valve stenosis was associated with a 30-day mortality rate of 35.3%. Conclusions: CO following TAVR is associated with a high procedural and 30-day mortality rate despite aggressive resuscitative measures including percutaneous coronary intervention.

Original languageEnglish (US)
Pages (from-to)229-236
Number of pages8
JournalCardiovascular Revascularization Medicine
Volume19
Issue number2
DOIs
StatePublished - Mar 1 2018

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Coronary Occlusion
Percutaneous Coronary Intervention
Mortality
Aortic Valve Stenosis
Publications
Transcatheter Aortic Valve Replacement
Coronary Vessels
Research Design
Demography

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical outcomes of coronary occlusion following transcatheter aortic valve replacement : A systematic review. / Akinseye, Oluwaseun A.; Jha, Sunil; Ibebuogu, Uzoma.

In: Cardiovascular Revascularization Medicine, Vol. 19, No. 2, 01.03.2018, p. 229-236.

Research output: Contribution to journalReview article

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abstract = "Background: Coronary occlusion (CO) is a rare but serious complication following transcatheter aortic valve replacement (TAVR) with limited published data. We sought to evaluate the immediate and short-term outcomes of CO complicating TAVR. Methods: Studies, including case reports, case series and original articles published from 2002 to 2016 describing CO following TAVR were identified with a systematic electronic search using the PRISMA Statement. Only studies reporting data on demographic and procedural characteristics, management and follow up outcomes were analyzed. Results: A total of 40 publications describing 96 patients (86 native, 10 bioprosthetic) were identified. Mean age was 83 ± 7 years and most (81{\%}) were females. The mean logistic EuroSCORE and STS score was 23.5 ± 14.6{\%} and 9.1 ± 3.2{\%} respectively. TAVR access site was transfemoral in 73{\%} and a balloon expandable valve was used in 78{\%}. Among those with LCA occlusion, the mean LCA ostium height was 10.1 ± 1.8 mm while the mean RCA ostium height was 10.4 ± 2.0 mm among those with RCA occlusion. CO frequently involved the left main coronary artery (80{\%}) and the most common mechanism was displacement of native valve leaflet (60{\%}), and most cases occurred within 1-hour post-implantation (88{\%}). Percutaneous coronary intervention was attempted in 82 patients and successful in 89{\%}. Procedural death was 10.4{\%}. CO following TAVR in native aortic valve stenosis was associated with a 30-day mortality rate of 35.3{\%}. Conclusions: CO following TAVR is associated with a high procedural and 30-day mortality rate despite aggressive resuscitative measures including percutaneous coronary intervention.",
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AB - Background: Coronary occlusion (CO) is a rare but serious complication following transcatheter aortic valve replacement (TAVR) with limited published data. We sought to evaluate the immediate and short-term outcomes of CO complicating TAVR. Methods: Studies, including case reports, case series and original articles published from 2002 to 2016 describing CO following TAVR were identified with a systematic electronic search using the PRISMA Statement. Only studies reporting data on demographic and procedural characteristics, management and follow up outcomes were analyzed. Results: A total of 40 publications describing 96 patients (86 native, 10 bioprosthetic) were identified. Mean age was 83 ± 7 years and most (81%) were females. The mean logistic EuroSCORE and STS score was 23.5 ± 14.6% and 9.1 ± 3.2% respectively. TAVR access site was transfemoral in 73% and a balloon expandable valve was used in 78%. Among those with LCA occlusion, the mean LCA ostium height was 10.1 ± 1.8 mm while the mean RCA ostium height was 10.4 ± 2.0 mm among those with RCA occlusion. CO frequently involved the left main coronary artery (80%) and the most common mechanism was displacement of native valve leaflet (60%), and most cases occurred within 1-hour post-implantation (88%). Percutaneous coronary intervention was attempted in 82 patients and successful in 89%. Procedural death was 10.4%. CO following TAVR in native aortic valve stenosis was associated with a 30-day mortality rate of 35.3%. Conclusions: CO following TAVR is associated with a high procedural and 30-day mortality rate despite aggressive resuscitative measures including percutaneous coronary intervention.

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