Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Cardiovascular Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
J Am Coll Cardiol. 2018 Mar 27;71(12):1360-1378. doi: 10.1016/j.jacc.2018.01.057.
Transcatheter aortic valve replacement (TAVR) has revolutionized the management of patients with symptomatic severe aortic stenosis, and indications are expanding towards treating younger patients with lower-risk profiles. Given the progressive nature of coronary artery disease and its high prevalence in those with severe aortic stenosis, coronary angiography and percutaneous coronary intervention will become increasingly necessary in patients after TAVR. There are some data suggesting that there are technical difficulties with coronary re-engagement, particularly in patients with self-expanding valves that, by design, extend above the coronary ostia. The authors review the challenges of coronary angiography and percutaneous coronary intervention post-TAVR and examine the geometric interactions between currently approved transcatheter aortic valves and coronary ostia, while providing a practical guide on how to manage these potentially complex situations.
经导管主动脉瓣置换术（TAVR）彻底改变了有症状的重度主动脉瓣狭窄患者的治疗方法，适应证正在向治疗低危-profile 的年轻患者扩展。鉴于冠状动脉疾病的进展性及其在重度主动脉瓣狭窄患者中的高发病率，TAVR 后患者行冠状动脉造影和经皮冠状动脉介入治疗将变得越来越必要。有一些数据表明，冠状动脉再介入存在技术困难，特别是对于自膨式瓣膜的患者，这些瓣膜的设计会延伸到冠状动脉口上方。作者回顾了 TAVR 后冠状动脉造影和经皮冠状动脉介入治疗的挑战，并研究了目前批准的经导管主动脉瓣与冠状动脉口之间的几何相互作用，同时提供了如何处理这些潜在复杂情况的实用指南。
