Objectives: Coronary artery obstruction is a rare and devastating complication of transcatheter aortic valve implantation (TAVI). The present study investigated the incidence, characteristics and outcome of this complication in Israeli TAVI registry.
Methods and Results: The Israeli TAVI registry is a database of TAVI procedures performed in Israel since the introduction of this technology in 2008. All ten Israeli centers that perform TAVI contribute to this registry. Of 1600 TAVI procedures nine cases of coronary artery obstruction were found. Six cases were following the implantation of an Edwards Sapien valve (1%) and three were following Medtronic Corevalve implantation (0.3%). All patients were females. Mean age was 82 ± 7 years, BMI 27 ± 3 and only 22% had a previous IHD. Left coronary artery (LCA) ostium height and aortic annulus diameter were 11.9 ± 1.9 mm and 21 ± 1 mm, respectively
Most cases were performed via the trans-femoral approach (78%), and the left coronary was obstructed in 78% of the cases. Hypotension was the presenting symptom in all cases, occurring immediately and up to ten minutes following valve deployment. Percutaneous coronary intervention was attempted in all the cases, and was successful in all but 2 cases that were fatal.
Conclusions: Coronary obstruction after TAVI is a rare occurring in 0.56% of the procedures. Women are more prone to this complication, featuring smaller aortic root apparatus dimensions. Percutaneous coronary intervention is feasible and should be attempted in all cases.
