A Very Late Presentation of a Right Coronary Artery Occlusion After Transcatheter Aortic Valve Replacement

Ramírez, Roberto; Ovakimyan, Oxana; Lasam, Glenmore; Lafferty, Kristen

doi:10.14740/cr559w

Cited by 11 publications

(20 citation statements)

References 8 publications

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“…The incidence of coronary obstruction has been reported in several TAVR trials to be less than 1% . However, the true incidence of this condition may be difficult to accurately define.…”

Section: Incidencementioning

confidence: 98%

“…However, the true incidence of this condition may be difficult to accurately define. Some authors have noted that occlusion may occur without hemodynamic compromise, making diagnosis difficult . The presence of patent coronary bypass grafts may mask any potential effects of ostial occlusion.…”

Section: Incidencementioning

confidence: 99%

“…Confirmation of occlusion can be obtained via TEE or more precisely via aortogram and coronary angiography. However, it should be noted that symptoms of coronary obstruction have been reported to occur up to 2 days after surgery …”

Section: Presentationmentioning

confidence: 99%

“…Nine patients (37.5%) were operated on via the transapical approach. Nearly 90% of these patients had a balloon expanding valve; however, coronary obstruction occured with self‐expanding valves as well …”

Section: Risk Factorsmentioning

confidence: 99%

“…These cases are most commonly due to cusp obstruction or stent frame/TAVR cusp impingement of the coronary ostia but may also be due to valve migration. Patients may also present with delayed coronary occlusion due to valve migration . It is rare for patients undergoing surgical AVR to have left coronary obstruction.…”

Section: Risk Factorsmentioning

confidence: 99%

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Management of coronary obstruction following transcatheter aortic valve replacement

et al. 2017

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Although occlusion of the coronary arteries during transcatheter aortic valve replacement is rare, the mortality is high. In this review, we discuss the prevention and management of this complication. Occlusion of coronary ostia is a very rare, but serious, complication of transcatheter aortic valve replacement (TAVR). Although reported as only occurring in <1% of TAVR cases, it carries a high risk of fatality, with some series reporting a mortality rate as high as 40%. We present the management of an occluded left coronary artery after a self-expanding TAVR, and review the incidence, prevention, and management of this complication.

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“…The incidence of coronary obstruction has been reported in several TAVR trials to be less than 1% . However, the true incidence of this condition may be difficult to accurately define.…”

Section: Incidencementioning

confidence: 98%

Section: Incidencementioning

confidence: 99%

Section: Presentationmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

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Management of coronary obstruction following transcatheter aortic valve replacement

et al. 2017

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Incidence, outcomes, and predictors of in‐hospital acute coronary syndrome following endovascular transcatheter aortic valve replacement in the United States

Nazir

Ahuja

Donato

et al. 2019

Cathet Cardio Intervent

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Background Incidence and outcomes of acute coronary syndrome (ACS) immediately following transcatheter aortic valve replacement (TAVR) remain largely unknown. Objectives This study sought to assess the incidence, clinical characteristics, and outcomes of ACS following TAVR. Methods We queried the National Readmission Database from January 2012 to September 2015 for TAVR admissions with and without ACS, creating a propensity‐matched cohort to compare outcomes. Results A total of 48,454 patients underwent TAVR, with 1,332 (2.75%) developing ACS. TAVR patients with ACS compared to those without ACS had a significantly higher incidence of acute kidney injury (24.7 vs. 19.2%; p = .001), ischemic stroke (3.7 vs. 2.3%; p = .04), vascular complications (8.6 vs. 5.8%; p = .008), cardiogenic shock (9.8 vs. 1.9%; p < .001), cardiac arrest (5.1 vs. 2.8%; p = .002), mechanical circulatory support (8.1 vs. 1.5%; p < .001), and in‐hospital mortality (9.6 vs. 3.4%; p < .001). Additionally, TAVR with ACS had longer lengths of stay (median 10 days vs. 6 days; p < .001) and hospital charges (median $23,200 vs. $19,000; p < .001). Positive predictors of ACS were history of PCI (odds ratio, 1.43; 95% CI: 1.25–1.63), hyperlipidemia (odds ratio, 1.20; 95% CI: 1.07–1.34), chronic blood loss anemia (odds ratio, 2.16; 95% CI: 1.54–3.03), chronic kidney disease (odds ratio, 1.17; 95% CI: 1.04–1.31), fluid and electrolyte disorders (odds ratio, 1.65; 95% CI: 1.47–1.85), and weight loss (odds ratio, 1.53; 95% CI: 1.22–1.91). Heart failure (34%) was the most common reason for readmission in the ACS cohort. Conclusion ACS after TAVR is uncommon but is associated with worse clinical outcomes and increased healthcare resource utilization.

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New Generation Devices for Transcatheter Aortic Valve Implantation

Iop

Gerosa

2019

Transcatheter Aortic Valve Implantation

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A Very Late Presentation of a Right Coronary Artery Occlusion After Transcatheter Aortic Valve Replacement

Cited by 11 publications

References 8 publications

Management of coronary obstruction following transcatheter aortic valve replacement

Management of coronary obstruction following transcatheter aortic valve replacement

Incidence, outcomes, and predictors of in‐hospital acute coronary syndrome following endovascular transcatheter aortic valve replacement in the United States

New Generation Devices for Transcatheter Aortic Valve Implantation

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