Laval University, Quebec Heart & Lung Institute, Quebec, Canadá
Instituto de Cardiologia do Rio Grande do Sul, Porto AlegreRS, Brasil.
Arq Bras Cardiol. 2014 Jan;102(1):93-6. doi: 10.5935/abc.20130252.
Transcatheter aortic valve implantation (TAVI) was established as an important alternative for high-risk patients with severe aortic stenosis. However, there are few data in the literature regarding coronary obstruction, that although rare, is a potentially fatal complication.
Evaluate this complication in Brazil.
We evaluated all patients presenting coronary obstruction from the Brazilian Registry of TAVI. Main baseline and procedural characteristics, management of the complication, and clinical outcomes were collected from all patients.
From 418 consecutive TAVI procedures, coronary obstruction occurred in 3 cases (incidence of 0.72%). All patients were women, without prior coronary artery bypass grafting (CABG), and with mean age of 85 ± 3 years, logistic EuroSCORE of 15 ± 6% and STS-PROM score of 9 ± 4%. All of the cases were performed with balloon-expandable Sapien XT prosthesis. In one patient, with pre-procedural computed tomography data, coronary arteries presented a low height and a narrow sinus of Valsalva. All patients presented with clinically significant severe maintained hypotension, immediately after valve implantation, and even though coronary angioplasty with stent implantation was successfully performed in all cases, patients died during hospitalization, being two periprocedurally.
Coronary obstruction following TAVI is a rare but potentially fatal complication, being more frequent in women and with the balloon-expandable prosthesis. Anatomical factors might be related with its increased occurrence, highlighting the importance of a good pre-procedural evaluation of the patients in order to avoid this severe complication.
经导管主动脉瓣植入术（TAVI）已成为治疗高危重度主动脉瓣狭窄患者的重要替代方法。然而，关于冠状动脉阻塞的文献数据较少，尽管罕见，但这是一种潜在致命的并发症。
评估巴西的这种并发症。
我们评估了巴西 TAVI 注册中心所有出现冠状动脉阻塞的患者。从所有患者中收集了主要基线和手术特征、并发症处理以及临床结果。
在 418 例连续 TAVI 手术中，3 例发生冠状动脉阻塞（发生率为 0.72%）。所有患者均为女性，无冠状动脉旁路移植术（CABG）史，平均年龄 85 ± 3 岁，逻辑 EuroSCORE 为 15 ± 6%，STS-PROM 评分为 9 ± 4%。所有病例均采用球囊扩张 Sapien XT 假体进行。在一例患者中，术前 CT 数据显示冠状动脉高度较低，主动脉窦较窄。所有患者在植入瓣膜后立即出现严重持续低血压，尽管所有患者均成功进行了经皮冠状动脉成形术和支架植入术，但患者在住院期间死亡，其中 2 例为围手术期死亡。
TAVI 后冠状动脉阻塞是一种罕见但潜在致命的并发症，在女性和使用球囊扩张假体的患者中更为常见。解剖因素可能与该并发症的发生率增加有关，这突显了对患者进行良好术前评估的重要性，以避免这种严重并发症。
