Boukantar Madjid, Gallet Romain, Mouillet Gauthier, Belarbi Abdelkaoui, Rubimbura Vladimir, Ternacle Julien, Dubois-Rande Jean-Luc, Teiger Emmanuel
Department of Cardiovascular, Henri Mondor University Hospital, Creteil, France.
J Interv Cardiol. 2017 Feb;30(1):56-62. doi: 10.1111/joic.12363. Epub 2017 Jan 11.
To evaluate the feasibility of coronary procedures after transcatheter aortic valve implantation (TAVI) with the CoreValve™ device.
Due to its design, CoreValve™ prosthesis may interfere with coronary procedures. Data on this issue are sparse.
Between 2007 and 2015, 550 patients underwent CoreValve™ TAVI in our hospital. Among them, 16 underwent coronary angiogram after TAVI and were included in our retrospective study. For each patient, we compared the characteristics of coronary angiograms performed before and after TAVI.
Coronary angiogram was deemed successful in 9 patients. The mean number of different catheters used in attempts to cannulate the coronary arteries was 3.6 ± 1.4 and the rate of selective intubation was low. Fluoroscopy time (13.2 ± 5.8 vs. 7.2 ± 4.6 min, P = 0.003), dose area product (5,347 ± 4,919 vs. 3,433 ± 3,420 cGy/m , P = 0.004), and contrast volume (157.7 ± 69.6 vs. 108.3 ± 42.6 mL, P = 0.006) were more important in coronary angiograms performed after CoreValve™ implantation. Percutaneous coronary intervention was successfully performed in 6 out of 7 patients who required it.
Coronary procedures after CoreValve™ TAVI are feasible, but challenging. This problem is currently rare but will be more common as the indications of TAVI are expanded to younger patients with longer life expectancies. Recommendations for post-TAVI coronary procedures are needed, particularly for centers unfamiliar with the management of post-TAVI patients.
评估使用CoreValve™装置经导管主动脉瓣植入术（TAVI）后进行冠状动脉介入操作的可行性。
由于其设计，CoreValve™人工瓣膜可能会干扰冠状动脉介入操作。关于此问题的数据较少。
2007年至2015年期间，我院有550例患者接受了CoreValve™ TAVI。其中，16例在TAVI后接受了冠状动脉造影，并纳入我们的回顾性研究。对于每位患者，我们比较了TAVI前后进行的冠状动脉造影的特征。
9例患者的冠状动脉造影被认为成功。尝试插入冠状动脉时使用的不同导管的平均数量为3.6±1.4，选择性插管率较低。在CoreValve™植入后进行的冠状动脉造影中，透视时间（13.2±5.8 vs. 7.2±4.6分钟，P = 0.003）、剂量面积乘积（5,347±4,919 vs. 3,433±3,420 cGy/m，P = 0.004）和造影剂用量（157.7±69.6 vs. 108.3±42.6 mL，P = 0.006）更为重要。7例需要进行经皮冠状动脉介入治疗的患者中有6例成功进行了该治疗。
CoreValve™ TAVI后进行冠状动脉介入操作是可行的，但具有挑战性。这个问题目前很少见，但随着TAVI的适应证扩大到预期寿命更长的年轻患者，将会变得更加普遍。需要针对TAVI后冠状动脉介入操作提出建议，特别是对于不熟悉TAVI后患者管理的中心。
