title: Clinical impact of coronary protection during transcatheter aortic valve implantation: first reported series of patients.
abstract: OBJECTIVE
  Coronary protection with guidewires and an undeployed coronary balloon or stent positioned in the coronary artery is a pre-emptive technique to manage coronary obstruction during transcatheter aortic valve implantation (TAVI). We investigated the feasibility and safety of left main (LM) protection during TAVI.
  
  
  RESULTS
  Twenty-five out of 623 patients who underwent TAVI at our institute were deemed to be at increased risk of LM compromise mainly due to a low LM ostium height, significant LM disease or a previous bioprosthetic valve. A pre-emptive LM protection technique was therefore used in these cases. Five patients (20%) had pre-TAVI significant non-revascularised LM stenosis, and four patients (16%) had a prior LM ostial stent without pre-TAVI in-stent restenosis. Twelve patients had extremely low LM height (mean height 6.7±2.4 mm; range 1.1-8.9 mm). Seven patients (25%) had valve-in-valve (VIV) procedures. LM compromise occurred in five out of 25 cases; all were treated successfully with emergency LM stenting. Nine patients underwent successful planned LM procedures following TAVI.
  
  
  CONCLUSIONS
  The LM protection technique should be considered in patients deemed to be at increased risk of LM compromise. This was found to be helpful in the prompt diagnosis and treatment of LM compromise following TAVI.
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Abramowitz
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kashif
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kazuno
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takahashi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Maeno
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000517:prevention & control*; D023903:Coronary Restenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D054855:Drug-Eluting Stents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional