title: Coronary obstruction following transcatheter aortic valve implantation: a systematic review.
abstract: OBJECTIVE
  This study sought to evaluate, through a systematic review of the published data, the main baseline characteristics, management, and clinical outcomes of patients suffering coronary obstruction as a complication of transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  Very few data exist on coronary obstruction after TAVI.
  
  
  METHODS
  Studies published between 2002 and 2012, with regard to coronary obstruction as a complication of TAVI, were identified with a systematic electronic search. Only the studies reporting data on the main baseline and procedural characteristics, management of the complication, and clinical outcomes were analyzed.
  
  
  RESULTS
  A total of 18 publications describing 24 patients were identified. Most (83%) patients were women, with a mean age of 83 ± 7 years and a mean logistic European System for Cardiac Operative Risk Evaluation score of 25.1 ± 12.0%. Mean left coronary artery (LCA) ostium height and aortic root width were 10.3 ± 1.6 mm and 27.8 ± 2.8 mm, respectively. Most patients (88%) had received a balloon-expandable valve, and coronary obstruction occurred more frequently in the LCA (88%). Percutaneous coronary intervention was attempted in 23 cases (95.8%) and was successful in all but 2 patients (91.3%). At 30-day follow-up, there were no cases of stent thrombosis or repeat revascularization, and the mortality rate was 8.3%.
  
  
  CONCLUSIONS
  Reported cases of coronary obstruction after TAVI occurred more frequently in women, in patients receiving a balloon-expandable valve, and the LCA was the most commonly involved artery. Percutaneous coronary intervention was a feasible and successful treatment in most cases. Continuous efforts should be made to identify the factors associated with this life-threatening complication to implement the appropriate measures for its prevention.
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Henrique Barbosa
authors.initials: HB
authors.lastname: Ribeiro
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.forename: Michael
authors.initials: M
authors.lastname: Mok
authors.forename: Sergio
authors.initials: S
authors.lastname: Pasian
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Robert
authors.initials: R
authors.lastname: DeLarochellière
authors.forename: Mélanie
authors.initials: M
authors.lastname: Côté
authors.forename: Louis
authors.initials: L
authors.lastname: Laflamme
authors.forename: Hugo
authors.initials: H
authors.lastname: DeLarochellière
authors.forename: Ricardo
authors.initials: R
authors.lastname: Allende
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D062645:Percutaneous Coronary Intervention; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome