Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia.
Cardiovasc Revasc Med. 2021 Jul;28S:94-97. doi: 10.1016/j.carrev.2020.12.013. Epub 2020 Dec 11.
Coronary artery obstruction (CAO) during transcatheter-aortic-valve replacement (TAVR) represents a main concern for TAVR safety in patients with low coronary take-off. To date, "snorkel" (also called chimney) technique, consisting of stent implantation from the coronary ostium to the aorta within the space between the valve frame and the aortic wall, is the most adopted strategy to prevent CAO. This technique is associated with the creation of complex valve/stent configuration that can hinder repeat coronary interventions. Due to this concern, we set up an original sequence for coronary protection aiming to ensure a more physiological TAVR frame/stent configuration. According to this technique, TAVR prosthesis is released with a "protection" system consisting of guiding catheter (GC), wire and stent inside the coronary artery with high CAO risk. In the case of CAO occurrence, the stent is released according to the snorkel technique. In the absence of complete CAO, a new GC is advanced inside the implanted TAVR prosthesis and the stent is deployed from the coronary artery up to the prosthesis. We herein report two cases of very high CAO risk where this technique was successfully used during last-generation self-expandable prostheses implantation (in a native aortic valve and in one prosthetic aortic valve). In conclusion, this "orthotopic snorkel-stenting in TAVR" (OST) technique represents a novel option for treating impeding CAO during TAVR. As compared with the "classic" snorkel technique, it allows avoiding stent implantation in some patients (who do not experience CAO) and may provide a more predictable and physiologic TAVR prosthesis/stent configuration in the case of stent implantation need.
经导管主动脉瓣置换术（TAVR）期间的冠状动脉阻塞（CAO）是低冠状动脉起始患者 TAVR 安全性的主要关注点。迄今为止，“通气管”（也称为烟囱）技术是最常用的策略，包括在瓣架和主动脉壁之间的空间内从冠状动脉口向主动脉内植入支架，以防止 CAO。该技术与创建复杂的瓣膜/支架结构相关，这可能会阻碍重复的冠状动脉介入治疗。出于这个考虑，我们建立了一个原始的冠状动脉保护序列，旨在确保更生理性的 TAVR 框架/支架结构。根据该技术，TAVR 假体在具有高 CAO 风险的冠状动脉内使用“保护”系统（包括引导导管（GC）、导丝和支架）释放。如果发生 CAO，根据通气管技术释放支架。如果没有完全的 CAO，则将新的 GC 推进到已植入的 TAVR 假体内部，并从冠状动脉向上部署支架到假体。我们在此报告了两例非常高的 CAO 风险病例，在这两种情况下，该技术都成功地用于上一代自扩张假体植入术（在原生主动脉瓣和一个人造主动脉瓣中）。总之，这种“TAVR 中的原位通气管支架置入术”（OST）技术是治疗 TAVR 期间阻碍性 CAO 的一种新选择。与“经典”通气管技术相比，它可以避免一些没有发生 CAO 的患者植入支架，并在需要支架植入时提供更可预测和生理性的 TAVR 假体/支架结构。
