Incidence, predictors, and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: insights from the VIVID registry

Abstract

Coronary obstruction following aortic ViV procedures is a life-threatening complication that occurred more frequently in patients with prior stentless or stented bioprostheses with externally mounted leaflets and in those with a short VTC.

Transcatheter aortic valve replacement in failed surgical valves

“…Eighty per cent of patients with unsuccessful PCI died 30. Thirty-six per cent of obstructions were delayed and most of these (77%) took place in patients with self-expandable devices, as these tend to continue expanding after the procedure is complete 30. A similar phenomenon has been described in native TAVR interventions, however, the risk for this complication in non-ViV conditions is significantly lower 31…”

“…The rate of coronary obstruction in ViV is 1%–3.5% 9–12. The largest analysis published on the topic is a 1612 patient cohort with 37 coronary obstructions, with a total rate of 2.3% 30. Thirty-day mortality in patients who had coronary obstruction was 48.6% vs 3.7% in unaffected patients 30…”

“…Most patients with coronary obstruction presented with severe hypotension and electrocardiographic changes, such as ST segment elevation 30. Percutaneous coronary intervention (PCI) was attempted in 77.8% of patients and was successful in only 64.3% of attempts.…”

“…Percutaneous coronary intervention (PCI) was attempted in 77.8% of patients and was successful in only 64.3% of attempts. Eighty per cent of patients with unsuccessful PCI died 30. Thirty-six per cent of obstructions were delayed and most of these (77%) took place in patients with self-expandable devices, as these tend to continue expanding after the procedure is complete 30.…”

“…Stentless valves and stented ones with externally mounted leaflets, such as the Mitroflow (Livanova PLC, London, UK) and the Trifecta (Abbott), were the only factor independently associated with coronary obstruction in a model controlling for coronary artery bypass grafting to the left system, STS score and postdilation (OR 7.67; 95% CI 3.14 to 18.7; p<0.001) 30. It is possible that when the surgical ring is not present or when leaflets are mounted outside of the posts, the interaction between the surgical valve leaflets and the coronary ostium is more pronounced and the risk is higher.…”