Zhou Jiawei, Li Yuehuan, Shen Jinglun, Wu Kaisheng, Wang Jiangang, Yu Yi, Zhang Haibo
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
Rev Cardiovasc Med. 2024 Nov 20;25(11):407. doi: 10.31083/j.rcm2511407. eCollection 2024 Nov.
Coronary obstruction (CO) is a fatal complication in transcatheter aortic valve replacement (TAVR). However, data on the outcomes and details of coronary protection (CP) use in TAVR are limited.
We retrospectively analyzed the patients who had undergone CP during TAVR at our tertiary cardiac center from March 2017 to January 2024. CP was achieved by an undeployed coronary balloon or stent positioned within the coronary artery, which releases the stent at CO occurrence. Patients' computed tomography (CT) evaluation reports and perioperative and follow-up outcomes were reviewed.
A total of 33 out of 493 patients (6.7%) underwent CP during TAVR due to the high risk of CO based on preoperative CT analysis. The mean sinus dimensions measured 30.1 ± 3.6 mm, 29.2 ± 3.4 mm, and 30.4 ± 3.7 mm for the left, right, and non-coronary sinus, respectively. The average left main height was 11.7 mm, and the right coronary height was 14 mm. Self-expanding valves were used in 93.9% of the patients. Coronary balloons were used for CP in 30 patients, whereas undeployed coronary stents were used in three cases. A total of 36 coronary arteries were protected, including 28 left coronary arteries alone, two right coronary arteries alone, and three dual coronary arteries. Eight patients (24.2%) developed CO and underwent stent release. The in-hospital and 30-day all-cause mortality rates were 9.1% and 0%, respectively. The median follow-up time was 10 months, and only one patient died 2 months after discharge due to stroke during the follow-up.
Pre-emptive coronary balloons or stents for CP allow for revascularization in the shortest possible time in the event of CO. Early and mid-term outcomes of CP during TAVR in patients with a high risk of CO show that CP is safe and feasible.
冠状动脉阻塞（CO）是经导管主动脉瓣置换术（TAVR）中的一种致命并发症。然而，关于TAVR中冠状动脉保护（CP）使用的结果和细节的数据有限。
我们回顾性分析了2017年3月至2024年1月在我们的三级心脏中心接受TAVR期间进行CP的患者。CP通过放置在冠状动脉内的未展开冠状动脉球囊或支架实现，在发生CO时释放支架。审查了患者的计算机断层扫描（CT）评估报告以及围手术期和随访结果。
基于术前CT分析，493例患者中有33例（6.7%）在TAVR期间因CO风险高而接受了CP。左、右和无冠状动脉窦的平均窦尺寸分别为30.1±3.6mm、29.2±3.4mm和30.4±3.7mm。左主干高度平均为11.7mm，右冠状动脉高度为14mm。93.9%的患者使用了自膨胀瓣膜。30例患者使用冠状动脉球囊进行CP，3例使用未展开的冠状动脉支架。总共保护了36条冠状动脉，其中仅28条左冠状动脉、2条右冠状动脉和3条双冠状动脉。8例患者（24.2%）发生CO并接受了支架释放。住院和30天全因死亡率分别为9.1%和0%。中位随访时间为10个月，随访期间仅1例患者在出院2个月后因中风死亡。
用于CP的预防性冠状动脉球囊或支架可在发生CO时在尽可能短的时间内实现血管重建。CO风险高的患者在TAVR期间进行CP的早期和中期结果表明CP是安全可行 的。
