Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2021 Mar;62(3):209-214. doi: 10.3349/ymj.2021.62.3.209.
Acute coronary occlusion is a rare but fatal complication that may occur during trans-catheter aortic valve implantation (TAVI) and appears more frequently in patients with low coronary heights. We evaluated the feasibility of self-expanding valves in patients with low coronary heights undergoing TAVI.
TAVI for native aortic valve stenosis was conducted in 276 consecutive patients between 2015 and 2019 at our institute. Using multi-detector computed tomography (MDCT), information on the aortic valve, coronary arteries, and vascular anatomy in 269 patients was analyzed. Patients with low coronary heights were defined as those with coronary heights of 10 mm or less during MDCT analysis.
Among the 269 patients, 29 (10.8%) patients had coronary arteries with low heights. The mean coronary height was 8.9±1.2 mm in the left coronary artery. These patients with low coronary heights were treated with self-expandable (n=28) or balloon-expandable (n=1) valves. Prophylactic coronary protection with a guidewire, balloon, or stent prepositioned down at-risk coronary arteries was not pursued in all patients. No acute coronary occlusion occurred in any of these patients during TAVI. Five patients (17.9%) died during follow-up (average of 553.8 days), including four from non-cardiogenic causes and one from a cardiogenic (aggravation of heart failure) cause.
A considerable number of patients with low coronary heights were observed among TAVI candidates in this study. Use of a self-expandable valve may be feasible for successful TAVI without acute coronary occlusion in patients with low coronary heights.
急性冠状动脉闭塞是经导管主动脉瓣植入术（TAVI）中罕见但致命的并发症，在冠状动脉高度较低的患者中更为常见。我们评估了在接受 TAVI 的冠状动脉高度较低的患者中使用自膨式瓣膜的可行性。
2015 年至 2019 年，我们在本机构对 276 例连续的原发性主动脉瓣狭窄患者进行了 TAVI。使用多探测器 CT（MDCT）分析了 269 例患者的主动脉瓣、冠状动脉和血管解剖学信息。在 MDCT 分析中，冠状动脉高度小于等于 10mm 的患者被定义为冠状动脉高度较低的患者。
在 269 例患者中，29 例（10.8%）患者的冠状动脉高度较低。左冠状动脉的平均冠状动脉高度为 8.9±1.2mm。这些冠状动脉高度较低的患者使用自膨式（n=28）或球囊扩张式（n=1）瓣膜进行治疗。在所有患者中，均未采用预置于高危冠状动脉的导丝、球囊或支架进行预防性冠状动脉保护。在这些患者中，TAVI 期间均未发生急性冠状动脉闭塞。5 例患者（17.9%）在随访期间死亡（平均随访时间为 553.8 天），包括 4 例非心源性死亡和 1 例心源性死亡（心力衰竭加重）。
在这项研究中，相当一部分 TAVI 候选患者存在冠状动脉高度较低的情况。在冠状动脉高度较低的患者中，使用自膨式瓣膜可能可以成功进行 TAVI，而不会发生急性冠状动脉闭塞。
