Delayed Coronary Occlusion After Transcatheter Aortic Valve Implantation: Implications for New Transcatheter Heart Valve Design and Patient Management

Abstract

Transcatheter aortic valve implantation has revolutionised the treatment of patients with severe aortic stenosis and is the preferred treatment option for patients with elevated surgical risk. Outcomes have continually improved, but because of the nature of the procedure infrequent catastrophic complications, such as coronary obstruction, persist. Recently, data were published regarding delayed coronary obstruction (DCO), a phenomenon in which the obstruction occurs after the index procedure. DCO has important consequences for future research. In this article we will explore the implications for new transcatheter heart valve design and approaches to patient management to minimise the risk of DCO occurring.

Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement

“…Jabbour et al. (11) have proposed other approaches that may help prevent coronary obstruction. For example, direct anchoring of THV to aortic leaflets may reduce the risk of prolapse and coronary obstruction.…”

“…Interestingly, BASILICA with subsequent supra-annular valve implantation compared with intra-annular valve implantation may result in improved flow dynamics in the neosinus (12) . Currently, the ATLANTIS (Anti-Thrombotic Strategy After Trans-Aortic Valve Implantation for Aortic Stenosis; NCT02664649 ) trial is investigating anticoagulation strategies in TAVR; the results may provide insight into pharmacological means of preventing DCO (11) . As TAVR inevitably drifts toward a greater number of potential candidates at lower surgical risk and younger age, challenging anatomical substrates will continue to fuel the desire to develop techniques and valve iterations that will obviate complications such as coronary obstruction.…”