Risk and Mitigation of Coronary Obstruction in Transcatheter Aortic Valve Replacement

Giorgio A Medranda; Toby Rogers

doi:10.1016/j.iccl.2021.05.004

Risk and Mitigation of Coronary Obstruction in Transcatheter Aortic Valve Replacement

Interv Cardiol Clin. 2021 Oct;10(4):481-490. doi: 10.1016/j.iccl.2021.05.004.

Authors

Giorgio A Medranda¹, Toby Rogers²

Affiliations

¹ Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B1, Washington, DC 20010, USA.
² Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B1, Washington, DC 20010, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA. Electronic address: toby.rogers@medstar.net.

PMID: 34593111
DOI: 10.1016/j.iccl.2021.05.004

Abstract

Acute coronary artery occlusion is a rare but devastating complication of transcatheter aortic valve replacement. Coronary obstruction is angiographic evidence of a new-partial or complete-obstruction of a coronary artery. Key factors identifying patients at risk are aortic root anatomy, type of aortic valve, and type of transcatheter heart valve. Techniques to prevent coronary obstruction include intentional leaflet laceration. If acute coronary obstruction does occur, bailout stenting can be challenging and conversion to emergent open heart surgery may be required, both of which are associated with high morbidity and mortality.

Keywords: BASILICA; Coronary obstruction; TAVR; Transcatheter aortic valve replacement; Valve-in-valve.

Publication types

Review

MeSH terms

Bioprosthesis*
Coronary Occlusion* / etiology
Coronary Occlusion* / prevention & control
Heart Valve Prosthesis*
Humans
Prosthesis Design
Transcatheter Aortic Valve Replacement* / adverse effects
Treatment Outcome