title: Coronary obstruction following transcatheter aortic valve implantation.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) was established as an important alternative for high-risk patients with severe aortic stenosis. However, there are few data in the literature regarding coronary obstruction, that although rare, is a potentially fatal complication.
  
  
  OBJECTIVE
  Evaluate this complication in Brazil.
  
  
  METHODS
  We evaluated all patients presenting coronary obstruction from the Brazilian Registry of TAVI. Main baseline and procedural characteristics, management of the complication, and clinical outcomes were collected from all patients.
  
  
  RESULTS
  From 418 consecutive TAVI procedures, coronary obstruction occurred in 3 cases (incidence of 0.72%). All patients were women, without prior coronary artery bypass grafting (CABG), and with mean age of 85 ± 3 years, logistic EuroSCORE of 15 ± 6% and STS-PROM score of 9 ± 4%. All of the cases were performed with balloon-expandable Sapien XT prosthesis. In one patient, with pre-procedural computed tomography data, coronary arteries presented a low height and a narrow sinus of Valsalva. All patients presented with clinically significant severe maintained hypotension, immediately after valve implantation, and even though coronary angioplasty with stent implantation was successfully performed in all cases, patients died during hospitalization, being two periprocedurally.
  
  
  CONCLUSIONS
  Coronary obstruction following TAVI is a rare but potentially fatal complication, being more frequent in women and with the balloon-expandable prosthesis. Anatomical factors might be related with its increased occurrence, highlighting the importance of a good pre-procedural evaluation of the patients in order to avoid this severe complication.
authors.affiliation: Laval University, Quebec Heart & Lung Institute, Quebec, Canadá
authors.forename: Henrique Barbosa
authors.initials: HB
authors.lastname: Ribeiro
authors.affiliation: Instituto de Cardiologia do Rio Grande do Sul, Porto AlegreRS, Brasil.
authors.forename: Rogério
authors.initials: R
authors.lastname: Sarmento-Leite
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São PauloSP, Brasil.
authors.forename: Dimytri A A
authors.initials: DA
authors.lastname: Siqueira
authors.affiliation: Hospital Pró-Cardíaco, Rio de JaneiroRJ, Brasil.
authors.forename: Luiz Antônio
authors.initials: LA
authors.lastname: Carvalho
authors.affiliation: Hospital Beneficência Portuguesa de São Paulo, São PauloSP, Brasil.
authors.forename: José Armando
authors.initials: JA
authors.lastname: Mangione
authors.affiliation: Laval University, Quebec Heart & Lung Institute, Quebec, Canadá
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.affiliation: Hospital Israelita Albert Einstein, São PauloSP, Brasil.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Perin
authors.affiliation: Hospital Israelita Albert Einstein, São PauloSP, Brasil.
authors.forename: Fábio Sandoli de
authors.initials: FS
authors.lastname: Brito
mesh_terms: D000369:Aged, 80 and over; D017130:Angioplasty; D001024:Aortic Valve Stenosis / Q000601:surgery; D001705:Bioprosthesis / Q000009:adverse effects*; D006328:Cardiac Catheterization / Q000009:adverse effects; D054059:Coronary Occlusion / Q000209:etiology*; D054855:Drug-Eluting Stents; D017809:Fatal Outcome; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D011183:Postoperative Complications; D012307:Risk Factors; D016896:Treatment Outcome