1. Feasibility of transcatheter aortic valve implantation in patients with coronary heights ≤7 mm: insights from the transcatheter aortic valve implantation Karlsruhe (TAVIK) registry.
- Author
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Conzelmann LO, Würth A, Schymik G, Schröfel H, Anusic T, Temme S, Tzamalis P, Gerhardus J, Mukherjee C, Gonska BD, Schmitt C, and Mehlhorn U
- Subjects
- Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve Stenosis diagnosis, Bioprosthesis, Coronary Angiography, Coronary Occlusion etiology, Feasibility Studies, Female, Fluoroscopy, Follow-Up Studies, Germany epidemiology, Humans, Incidence, Male, Postoperative Complications epidemiology, Postoperative Complications etiology, Prospective Studies, Survival Rate trends, Transcatheter Aortic Valve Replacement adverse effects, Treatment Outcome, Aortic Valve surgery, Aortic Valve Stenosis surgery, Coronary Occlusion diagnosis, Coronary Vessels diagnostic imaging, Postoperative Complications diagnosis, Registries, Transcatheter Aortic Valve Replacement methods
- Abstract
Objectives: Transcatheter aortic valve implantation (TAVI) in patients with low coronary heights is generally denied but is not impossible. Information about these high-risk procedures is sparse., Methods: Since May 2008, data of more than 3000 patients who had TAVI were prospectively collected in the institutional TAVI Karlsruhe registry. Characteristics, peri- and postoperative outcome of patients with low coronary heights of ≤7 mm were analysed according to the Valve Academic Research Consortium-2., Results: Eighty-six patients with an average coronary height of 6.4 ± 1.1 mm (mean age 81.0 ± 5.3 years, logistic EuroSCORE I 19.6 ± 13.3%) were treated. TAVI was performed in 72 transfemoral (83.7%) and 14 transapical (16.3%) cases using 44 CoreValve/Evolut R (51.2%), 21 Sapien XT/S3 (24.4%), 14 ACURATE (16.3%), 5 Lotus (5.8%) and 2 Portico (2.3%) prostheses. Ten procedures were valve-in-valve (VinV) TAVI (VinV, 11.6%). The 72-h, 30-day, 1-year and follow-up (3.0 ± 1.6 years) mortality rates were 2.3%, 8.0%, 10.5% and 26.7%, respectively. Within 30 days, 4 cardiac deaths and 3 non-cardiac deaths occurred (4.7% and 3.5%). Three coronary obstructions (3.5%) occurred-2 during VinV TAVI. One patient was connected to extracorporeal circulation that could not be weaned later due to an unsuccessful percutaneous coronary intervention. Another patient, the only conversion (1.2%), required delayed surgical valve replacement. The third patient died of right heart failure after aortic dissection. The procedural success rate was 95.3%. VinV procedures were associated with increased follow-up deaths (P < 0.001; hazard ratio 7.96)., Conclusions: Coronary-related complications in TAVI procedures in patients with coronary heights ≤7 mm occurred less frequently, but once they occurred, they were serious. These TAVI procedures are feasible, with a high procedural success rate, but meticulous preoperative planning should be mandatory. In VinV procedures, the follow-up mortality rate is increased; therefore, we do not recommend these procedures.
- Published
- 2018
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