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Operating Transverse Aortic Constriction with Absorbable Suture to Obtain Transient Myocardial Hypertrophy
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[TAVI and coronary revascularization]

N Combaret1, M Bouchant1, P Motreff1

  • 1Service de cardiologie, centre hospitalier universitaire Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.

Annales De Cardiologie Et D'Angeiologie
|October 26, 2019
PubMed

Insights

Transcatheter aortic valve implantation (TAVI) can be complicated by coronary artery occlusion, particularly affecting the left main coronary artery. Pre-procedural imaging is crucial for identifying high-risk patients to prevent serious complications.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Severe aortic stenosis often coexists with coronary artery disease in inoperable patients.
  • Transcatheter aortic valve implantation (TAVI) is a primary treatment for severe aortic stenosis.
  • The impact of coronary lesions on survival after TAVI remains debated.

Purpose of the Study:

  • To review the implications of coronary artery disease in patients undergoing TAVI.
  • To discuss the risks and management of coronary artery occlusion during TAVI.
  • To outline strategies for percutaneous coronary intervention (PCI) post-TAVI.

Main Methods:

  • Review of existing literature on TAVI and coronary artery disease.
  • Analysis of factors contributing to coronary artery occlusion during TAVI.
  • Discussion of imaging techniques for risk stratification.
  • Evaluation of PCI techniques following TAVI.

Main Results:

  • Coronary revascularization may benefit selected proximal lesions before or during TAVI.
  • Periprocedural coronary artery occlusion is rare but carries a poor prognosis, often involving the left main coronary artery.
  • Risk factors for occlusion include short implantation distance and small aortic sinuses.
  • Late occlusions are linked to thrombus or fibrosis.
  • PCI success rates after TAVI are often low due to procedural challenges.

Conclusions:

  • Pre-TAVI imaging is vital for identifying high-risk cases and implementing preventive measures.
  • Management strategies for coronary artery disease in TAVI patients require careful consideration.
  • Specific PCI techniques are necessary for managing coronary interventions post-TAVI.

Keywords:
Aortic stenosisCoronarographieCoronarographyCoronaropathieCoronary artery diseaseCoronary occlusionOcclusion coronaireRétrécissement aortiqueTAVI

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