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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
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Coronary Protection to Prevent Coronary Obstruction During TAVR: A Multicenter International Registry
Tullio Palmerini1, Tarun Chakravarty2, Francesco Saia1
1Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy.
JACC. Cardiovascular Interventions
|February 17, 2020
Summary
Preventive stenting during transcatheter aortic valve replacement (TAVR) improves survival and reduces cardiac death. Coronary protection with wires alone carries a significant risk of delayed coronary occlusion after TAVR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Coronary obstruction is a critical complication after transcatheter aortic valve replacement (TAVR).
- This complication leads to high procedural and short-term mortality rates.
Purpose of the Study:
- To evaluate the safety and effectiveness of preventive coronary stenting in high-risk TAVR patients.
- To assess outcomes of coronary protection strategies including wiring and stenting across coronary ostia.
Main Methods:
- Retrospective analysis of a multicenter international registry (April 2011 - February 2019).
- Compared outcomes between patients receiving preventive coronary wiring with stenting versus wiring alone.
- Follow-up at 3 years.
Main Results:
- Patients receiving stents had lower 3-year cardiac death rates (7.8% vs. 15.7%).
- Stent thrombosis occurred in 0.9% of stented patients, primarily in valve-in-valve procedures.
- Delayed coronary occlusion (DCO) occurred in 4.3% of patients with wire protection only.
Conclusions:
- Preventive coronary stenting in high-risk TAVR patients is associated with favorable mid-term survival.
- Coronary protection using only wires poses a substantial risk of DCO.
- Stent implantation demonstrates good safety with low thrombosis rates.
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