Khan Muhammad, Senguttuvan Nagendra Boopathy, Krishnamoorthy Parasuram, Vengrenyuk Yuliya, Tang Gilbert H L, Sharma Samin K, Kini Annapoorna
Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America.
Department of Cardiovascular Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America.
Int J Cardiol. 2020 Oct 15;317:18-24. doi: 10.1016/j.ijcard.2020.05.065. Epub 2020 Jun 1.
We aim to describe the feasibility, challenges, success rates and techniques utilized in coronary angiography (CA) and percutaneous coronary intervention (PCI) in patients post transcatheter aortic valve replacement (TAVR).
CA and PCI after TAVR are becoming increasingly encountered in clinical practice. There have been technical difficulties reported in re-accessing the coronary arteries through the self-expanding CoreValve prosthesis.
From January 2012 to November 2017, 672 patients who underwent TAVR with a self-expanding prosthesis were retrospectively reviewed and those who had a CA and/or PCI post TAVR were analysed. Clinical characteristics, angiographic and procedural details were obtained. A subgroup of patients had computed tomographic angiography (CTA) post TAVR to evaluate positions of the coronary ostia relative to the self-expanding prosthesis. Study endpoint was successful selective engagement of coronary ostia for CA and PCI.
Thirty-two patients (4.8%) had attempted 46 CA and 26 PCI after TAVR with a self-expanding valve. Mean age was 85.2 years and 41% were females. Selective left and right coronary angiography using standard catheters could be achieved in 50% and 28% of cases respectively. Successful PCI was performed in 25 cases (96%); however, significant technique modification was required in 64% of cases. CTA in 9 patients confirmed the difficulty in coronary re-access was due to a combination of the sealing skirt relationship to coronary ostia and sinotubular junction as well as commissural post orientation and significant native leaflet calcification.
CA and PCI post TAVR with self-expanding CoreValve is technically challenging but feasible with modification of standard techniques.
我们旨在描述经导管主动脉瓣置换术（TAVR）后患者进行冠状动脉造影（CA）和经皮冠状动脉介入治疗（PCI）的可行性、挑战、成功率及所采用的技术。
TAVR后的CA和PCI在临床实践中越来越常见。据报道，通过自膨胀式CoreValve假体重新进入冠状动脉存在技术困难。
回顾性分析2012年1月至2017年11月期间672例行自膨胀式假体TAVR的患者，分析TAVR后进行CA和/或PCI的患者。获取临床特征、血管造影和手术细节。一组患者在TAVR后进行计算机断层血管造影（CTA），以评估冠状动脉口相对于自膨胀式假体的位置。研究终点是CA和PCI时冠状动脉口的成功选择性介入。
32例患者（4.8%）在TAVR后使用自膨胀瓣膜尝试了46次CA和26次PCI。平均年龄为85.2岁，41%为女性。分别有50%和28%的病例能够使用标准导管进行选择性左、右冠状动脉造影。25例（96%）成功进行了PCI；然而，64%的病例需要进行重大技术改进。9例患者的CTA证实，冠状动脉重新进入困难是由于密封裙与冠状动脉口和窦管交界处的关系、连合后方向以及严重的原生瓣叶钙化共同导致的。
使用自膨胀式CoreValve进行TAVR后的CA和PCI在技术上具有挑战性，但通过改进标准技术是可行的。
