Conzelmann LO, et al. - Researchers investigated the characteristics, peri- and postoperative outcome of patients with low coronary heights of ≤7mm undergoing transcatheter aortic valve implantation (TAVI). They noted that in patients with coronary heights ≤7mm, coronary-related complications in TAVI procedures occurred less frequently, but once they occurred, they were serious. These TAVI procedures are feasible, with a high procedural success rate, but meticulous preoperative planning should be mandatory. As the follow-up mortality rate is increased in valve-in-valve (VinV) procedures; these procedures were not recommended.

Methods

• Since May 2008, researchers prospectively collected data of more than 3000 patients who had TAVI in the institutional TAVI Karlsruhe registry.
• According to the Valve Academic Research Consortium-2, they analyzed characteristics, peri- and postoperative outcome of patients with low coronary heights of ≤7mm.

Results

• Researchers recognized 86 patients with an average coronary height of 6.4±1.1mm (mean age 81.0±5.3years, logistic EuroSCORE I 19.6±13.3%) that underwent treatment.
• In 72 transfemoral (83.7%) and 14 transapical (16.3%) cases, TAVI was performed using 44 CoreValve/Evolut R (51.2%), 21 Sapien XT/S3 (24.4%), 14 ACURATE (16.3%), 5 Lotus (5.8%) and 2 Portico (2.3%) prostheses.
• They noted that 10 procedures were valve-in-valve (VinV) TAVI (VinV, 11.6%).
• Findings demonstrated the 72-h, 30-day, 1-year and follow-up (3.0±1.6years) mortality rates of 2.3%, 8.0%, 10.5% and 26.7%, respectively.
• Four cardiac deaths and 3 non-cardiac deaths occurred within 30days, (4.7% and 3.5%).
• They noted 3 coronary obstructions (3.5%)--2 occurred during VinV TAVI.
• One patient was connected to extracorporeal circulation; due to an unsuccessful percutaneous coronary intervention, this patient could not be weaned later.
• Delayed surgical valve replacement was performed on another patient, the only conversion (1.2%).
• The third patient died of right heart failure after aortic dissection.
• The procedural success rate of 95.3% was noted.
• Increased follow-up deaths were noted in association with VinV procedures (P < 0.001; hazard ratio 7.96).