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Coronary obstruction after TAVR rare but potentially fatal
Women and older adults were at an increased risk for mortality resulting from coronary obstruction after transcatheter aortic valve replacement, according to recent results.
For the study, researchers enrolled a cohort of 44 patients with symptomatic coronary obstruction after TAVR who had been culled from a multicenter registry of 6,688 patients.
CT data from before TAVR were available for 28 adults in the coronary obstruction patient cohort and 345 patients who served as controls.
Older age (P<.001), female sex (P<.001), no previous CABG (P=.043), the use of a balloon-expandable valve (P=.023) and previous surgical aortic bioprosthesis (P=.045) were associated with coronary obstruction, according to the findings. The left coronary artery was involved in 88.6% of obstructed patients, which the researchers reported was the most common.
The mean left coronary artery ostia height was 10.7 ± 0.4 mm in obstructed case patients and 13.3 ± 0.3 mm in matched controls (OR=2.17; 95% CI, 1.62-2.90). Patients with coronary obstruction also demonstrated lower sinus of Valsalva diameter (28.3 ± 0.8 mm vs. 31.3 ± 0.6 mm; OR=1.37; 95% CI, 1.13-1.66).
At presentation, 68.2% of patients exhibited persistent severe hypotension, whereas 56.8% exhibited ECG changes.
Clinicians attempted PCI in 75% of cases, which had a success rate of 81.8%. The mortality rate at 30 days was 40.9%.
The median follow-up duration was 12 months. At that point, a 45.5% cumulative mortality rate was observed, and no stent thrombosis or reintervention had occurred.
“Symptomatic coronary obstruction following TAVR was a rare but life-threatening complication that occurred more frequently in women, in patients receiving a balloon-expandable valve and in those with a prior surgical bioprosthesis,” the researchers wrote.
Acute and late mortality were high, even in the setting of successful intervention, they wrote, adding that prevention of coronary obstruction in this patient population remains critical to reduce this mortality.
Disclosure: Ribeiro reports no relevant financial disclosures. See the study for a full list of all other researchers’ relevant financial disclosures.
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