Coronary Catheterization and Percutaneous Interventions After Transcatheter Aortic Valve Implantation
Coronary Catheterization and Percutaneous Interventions After Transcatheter Aortic Valve Implantation
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DOI：
10.1016/j.amjcard.2016.10.046
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发表时间：
2017-08-15
影响因子：
2.8
通讯作者：
Ribichini, Flavio
中科院分区：
文献类型：
--
作者：
Zivelonghi, Carlo;Pesarini, Gabriele;Ribichini, Flavio
冠状动脉疾病（CAD）通常存在于严重主动脉瓣狭窄患者中，这些患者适合接受经导管主动脉瓣植入术（TAVI）。轻度CAD也可能在TAVI后数年恶化并需要治疗。经导管瓣膜的植入可能会干扰冠状动脉重新接合的能力。我们前瞻性评估了在接受TAVI的连续系列CAD患者中进行冠状动脉造影（CA）、血流储备分数和（如有指征）瓣膜植入后经皮冠状动脉介入治疗的可行性。根据准确的计算机断层扫描和主动脉根部结构的血管造影测量确定瓣膜类型和尺寸。我们分析了66例接受TAVI的连续患者，41例使用球囊扩张式瓣膜，25例使用自扩张式经导管瓣膜。除1例自膨式瓣膜高位植入后的左冠状动脉外，所有病例的右和左冠状动脉导管插入术（132支血管）均成功（失败率，1/50支血管）。在132支血管中的6支（4%），CA最初是非选择性的，但在定位0.014 "冠状动脉内guidevire后，所有这些病例都获得了选择性注射。根据血流储备分数测量结果，在19支冠状动脉血管（17例患者）中成功进行了经皮冠状动脉介入治疗：总之，在几乎所有病例中，使用球囊或自膨式瓣膜经股动脉TAVI后的冠状动脉口导管插入术都是安全可行的。准确的主动脉根部成像和手术计划可能有助于避免环上自膨式瓣膜植入过高，从而避免进入冠状动脉口的困难。使用冠状动脉内导丝有助于在难以进入的病例中进行选择性CA。(C)2016 Elsevier Inc. All rights reserved.
Coronary artery disease (CAD) is often present in patients with severe aortic valve stenosis candidates to transcatheter aortic valve implantation (TAVI). Mild CAD may also worsen and need treatment years after TAVI. The implantation of a transcatheter valve may interfere with the capability of reengaging the coronary arteries. We prospectively assessed the feasibility of performing coronary angiography (CA), fractional flow reserve, and, where indicated, percutaneous coronary intervention after valve implantation in a consecutive series of patients with CAD undergoing TAVI. Valve type and size were decided according to accurate computed tomography scan and angiographic measurement of the aortic root structures. We analyzed 66 consecutive patients undergoing TAVI, 41 with balloon expandable, and 25 with self-expandable transcatheter valves. Right and left coronary catheterization (132 vessels) was successful in all cases except in 1 left coronary artery after a high implantation of a self-expandable valve (unsuccess rate, 1 in 50 vessels). In 6 of 132 vessels (4%), CA was initially nonselective, but after positioning the 0.014 '' intracoronary guidevvire, selective injections were obtained in all these cases. Percutaneous coronary intervention was performed successfully in 19 coronary vessels (17 patients) as indicated by fractional flow reserve measurements: In conclusion, catheterization of the coronary ostia after transfemoral TAVI with balloon or self-expandable valves is safe and feasible in almost all cases. Accurate imaging of the aortic root and procedural planning may help to avoid too high implantation of supra-annular self-expandable valves to obviate difficulties in accessing coronary ostia. Use of intracoronary guidewires facilitates selective CA in cases with difficult access. (C) 2016 Elsevier Inc. All rights reserved.