title: Impact of preparatory coronary protection in patients at high anatomical risk of acute coronary obstruction during transcatheter aortic valve implantation.
abstract: BACKGROUND
  This study aimed to assess the effectiveness of preparatory coronary protection (CP) in patients considered at high risk of acute coronary obstruction (ACO) after transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  The Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) Japanese multicenter registry enrolled 666 consecutive patients. All patients were assessed by preprocedural multidetector computed tomography. CP using a guide wire with or without a balloon was prospectively performed according to the following criteria: 1) coronary height length from the annulus <10mm, 2) evidence of ACO during balloon aortic valvuloplasty with simultaneous aortic injection, and 3) shallow valsalva or bulky calcification on the leaflet. The incidence of ACO and other procedural outcomes were compared between the CP and non-CP groups.
  
  
  RESULTS
  CP was performed in 14.1% of all patients (94/666). ACO had an incidence of 1.5% (10/666) and mainly occurred in women (70%) and the left coronary artery (70%). The ACO rate was significantly higher in the CP group than in the non-CP group (7.4% [7/94] vs. 0.5% [3/572]; p<0.001), although notably 30% of ACO were occurred in non-CP group. All 10 ACO cases were successfully treated by catheter intervention, although periprocedural myocardial injury occurred in 42.9% of patients with CP group and 33.3% of those without CP group. Mortality and other periprocedural complications did not significantly differ between the 2 groups.
  
  
  CONCLUSIONS
  The preparatory CP strategy was feasible for the management of ACO during TAVI, but the complication of ACO was difficult to predict completely.
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan. Electronic address: masa-nori@nms.ac.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Shimura
authors.affiliation: Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kano
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Kagase
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Kodama
authors.affiliation: Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Koyama
authors.affiliation: Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Tada
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Motoharu
authors.initials: M
authors.lastname: Araki
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shirai
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D063126:Balloon Valvuloplasty / Q000379:methods*; D054059:Coronary Occlusion / Q000517:prevention & control*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Acute coronary obstruction; Coronary protection; Transcatheter aortic valve implantation