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Delayed Coronary Obstruction after Transcatheter Aortic Valve Replacement - An Uncommon But Serious Complication

Wei-Hsian Yin1,2, Yung-Tsai Lee1,3, Tien-Ping Tsao1,4

  • 1Heart Center, Cheng Hsin General Hospital.

Acta Cardiologica Sinica
|September 21, 2020
PubMed

Insights

Delayed coronary obstruction (DCO) is a rare complication after transcatheter aortic valve replacement (TAVR). This review examines DCO implications for pre-procedural planning, valve choice, and post-procedure care.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Transcatheter aortic valve replacement (TAVR) is increasingly the standard treatment for aortic stenosis.
  • Delayed coronary obstruction (DCO) is an uncommon but significant complication following TAVR.
  • The rising use of TAVR in lower-risk populations necessitates a thorough understanding of DCO.

Purpose of the Study:

  • To review the implications of delayed coronary obstruction (DCO) after transcatheter aortic valve replacement (TAVR).
  • To discuss the role of pre-procedural computed tomography (CT) in evaluating DCO risk.
  • To outline strategies for valve selection, intra-procedural management, and post-procedural care to mitigate DCO.

Main Methods:

  • Literature review focusing on delayed coronary obstruction following TAVR.
  • Analysis of pre-procedural CT findings relevant to DCO.
  • Examination of TAVR procedural techniques and valve characteristics impacting DCO.
  • Review of post-procedural management strategies for DCO.

Main Results:

  • Pre-procedural CT evaluation is crucial for identifying anatomical factors predisposing to DCO.
  • Appropriate valve selection and sizing can minimize the risk of coronary obstruction.
  • Intra-procedural techniques and post-procedural monitoring are essential for managing DCO.

Conclusions:

  • Delayed coronary obstruction is a critical complication of TAVR that requires careful consideration.
  • A multidisciplinary approach involving imaging, procedural technique, and vigilant post-procedural management is key to addressing DCO.
  • Further research is needed to refine strategies for preventing and managing DCO in TAVR patients.

Keywords:
ComplicationDelayed coronary obstructionTranscatheter aortic valve replacement

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