title: Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry.
abstract: OBJECTIVE
  This study sought to evaluate the main baseline and procedural characteristics, management, and clinical outcomes of patients from a large cohort of patients undergoing transcatheter aortic valve implantation (TAVI) who suffered coronary obstruction (CO).
  
  
  BACKGROUND
  Very little data exist on CO following TAVI.
  
  
  METHODS
  This multicenter registry included 44 patients who suffered symptomatic CO following TAVI of 6,688 patients (0.66%). Pre-TAVI computed tomography data was available in 28 CO patients and in a control group of 345 patients (comparisons were performed including all patients and a cohort matched 1:1 by age, sex, previous coronary artery bypass graft, transcatheter valve type, and size).
  
  
  RESULTS
  Baseline and procedural variables associated with CO were older age (p < 0.001), female sex (p < 0.001), no previous coronary artery bypass graft (p = 0.043), the use of a balloon-expandable valve (p = 0.023), and previous surgical aortic bioprosthesis (p = 0.045). The left coronary artery was the most commonly involved (88.6%). The mean left coronary artery ostia height and sinus of Valsalva diameters were lower in patients with obstruction than in control subjects (10.6 ± 2.1 mm vs. 13.4 ± 2.1 mm, p < 0.001; 28.1 ± 3.8 mm vs. 31.9 ± 4.1 mm, p < 0.001). Differences between groups remained significant after the case-matched analysis (p < 0.001 for coronary height; p = 0.01 for sinus of Valsalva diameter). Most patients presented with persistent severe hypotension (68.2%) and electrocardiographic changes (56.8%). Percutaneous coronary intervention was attempted in 75% of the cases and was successful in 81.8%. Thirty-day mortality was 40.9%. After a median follow-up of 12 (2 to 18) months, the cumulative mortality rate was 45.5%, and there were no cases of stent thrombosis or reintervention.
  
  
  CONCLUSIONS
  Symptomatic CO following TAVI was a rare but life-threatening complication that occurred more frequently in women, in patients receiving a balloon-expandable valve, and in those with a previous surgical bioprosthesis. Lower-lying coronary ostium and shallow sinus of Valsalva were associated anatomic factors, and despite successful treatment, acute and late mortality remained very high, highlighting the importance of anticipating and preventing the occurrence of this complication.
authors: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
authors: Henrique B
authors: HB
authors: Ribeiro
authors: John G
authors: JG
authors: Webb
authors: Raj R
authors: RR
authors: Makkar
authors: Mauricio G
authors: MG
authors: Cohen
authors: Samir R
authors: SR
authors: Kapadia
authors: Susheel
authors: S
authors: Kodali
authors: Corrado
authors: C
authors: Tamburino
authors: Marco
authors: M
authors: Barbanti
authors: Tarun
authors: T
authors: Chakravarty
authors: Hasan
authors: H
authors: Jilaihawi
authors: Jean-Michel
authors: JM
authors: Paradis
authors: Fabio S
authors: FS
authors: de Brito
authors: Sergio J
authors: SJ
authors: Cánovas
authors: Asim N
authors: AN
authors: Cheema
authors: Peter P
authors: PP
authors: de Jaegere
authors: Raquel
authors: R
authors: del Valle
authors: Paul T L
authors: PT
authors: Chiam
authors: Raúl
authors: R
authors: Moreno
authors: Gonzalo
authors: G
authors: Pradas
authors: Marc
authors: M
authors: Ruel
authors: Jorge
authors: J
authors: Salgado-Fernández
authors: Rogerio
authors: R
authors: Sarmento-Leite
authors: Hadi D
authors: HD
authors: Toeg
authors: James L
authors: JL
authors: Velianou
authors: Alan
authors: A
authors: Zajarias
authors: Vasilis
authors: V
authors: Babaliaros
authors: Fernando
authors: F
authors: Cura
authors: Antonio E
authors: AE
authors: Dager
authors: Ganesh
authors: G
authors: Manoharan
authors: Stamatios
authors: S
authors: Lerakis
authors: Augusto D
authors: AD
authors: Pichard
authors: Sam
authors: S
authors: Radhakrishnan
authors: Marco Antonio
authors: MA
authors: Perin
authors: Eric
authors: E
authors: Dumont
authors: Eric
authors: E
authors: Larose
authors: Sergio G
authors: SG
authors: Pasian
authors: Luis
authors: L
authors: Nombela-Franco
authors: Marina
authors: M
authors: Urena
authors: E Murat
authors: EM
authors: Tuzcu
authors: Martin B
authors: MB
authors: Leon
authors: Ignacio J
authors: IJ
authors: Amat-Santos
authors: Jonathon
authors: J
authors: Leipsic
authors: Josep
authors: J
authors: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D006328:Cardiac Catheterization / Q000009:adverse effects*; D015331:Cohort Studies; D054059:Coronary Occlusion / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D019468:Disease Management; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: CABG; CT; IQR; LCA; PCI; RCA; SOV; TAVI; TIMI; Thrombolysis In Myocardial Infarction; computed tomography; coronary artery bypass graft; coronary obstruction; coronary occlusion; interquartile range; left coronary artery; logEuroSCORE; logistic European System for Cardiac Operative Risk Evaluation score; percutaneous aortic valve replacement; percutaneous coronary intervention; right coronary artery; sinus of Valsalva; transcatheter aortic valve implantation