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Novelli A, Gogo P, Dauerman HL, Polomsky M. Management of severe aortic stenosis in the presence of an 8 mm right coronary stent protrusion. Catheter Cardiovasc Interv 2024. [PMID: 38860636 DOI: 10.1002/ccd.31120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/21/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024]
Abstract
Management of a protruding coronary stent into the aortic root in patients undergoing evaluation for transcatheter aortic valve replacement can be challenging. We describe a patient treated with stent trimming and surgical aortic valve replacement, highlighting the importance of a multidisciplinary evaluation and selection process in this complex scenario.
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Affiliation(s)
| | - Prospero Gogo
- University of Vermont Medical Center, Burlington, Vermont, USA
| | | | - Marek Polomsky
- University of Vermont Medical Center, Burlington, Vermont, USA
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2
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Damarkusuma A, Johar S, Patel B, Yung CC. Using Ping-pong technique along with rapid inflate-deflate ballooning to solve total left main occlusion during transcatheter aortic valve replacement procedure. Catheter Cardiovasc Interv 2024; 103:1088-1092. [PMID: 38639156 DOI: 10.1002/ccd.31059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
Coronary obstruction during transcatheter aortic valve replacement (TAVR) poses a significant threat, prompting a closer examination of prevention and bailout strategies. Following TAVR deployment with a coronary artery obstruction complication and recognizing the complexities involved in engaging the left main coronary artery through TAVR cells. This case introduces the "Ping-pong" technique using a second guide catheter. When faced with difficulty in engaging the catheter through TAVR cells, an innovative solution is proposed. Inserting a wire into the valsalva and utilizing a rapid inflate-deflate balloon maneuver successfully facilitates catheter access into the left main, offering a promising intervention for challenging scenarios. In conclusion, this study emphasizes the severe implications of coronary obstruction during TAVR. The innovative "Ping-pong" technique and rapid inflate-deflate balloons emerge as valuable interventions, showcasing their potential in challenging catheter engagement scenarios. These insights offer a promising avenue for enhancing patient outcomes in TAVR procedures.
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Affiliation(s)
- Arditya Damarkusuma
- Gleneagles Jerudong Park Medical Centre, Jerudong, Brunei Darussalam
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Sardjito General Hospital, Yogyakarta, Indonesia
| | - Sofian Johar
- Gleneagles Jerudong Park Medical Centre, Jerudong, Brunei Darussalam
- RIPAS Hospital Medical Centre, Bandar Seri Begawan, Brunei Darussalam
| | - Billal Patel
- Gleneagles Jerudong Park Medical Centre, Jerudong, Brunei Darussalam
| | - Chea Chin Yung
- Gleneagles Jerudong Park Medical Centre, Jerudong, Brunei Darussalam
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3
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Mylotte D, Wagener M. Chimneys and Basilicas: Do We Have White Smoke? JACC Cardiovasc Interv 2024; 17:753-755. [PMID: 38538171 DOI: 10.1016/j.jcin.2024.01.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland; Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland.
| | - Max Wagener
- Department of Cardiology, University Hospital Galway, Galway, Ireland
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4
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Gayosso-Ortíz JR, Garcia-Garcia JF, Merino-Rajme JA, Muratalla-González R, Fuentes-Moreno JC, Jiménez-Valverde AS, Alcantara-Melendez MA, Aquino-Bruno H. High risk of coronary artery obstruction during TAVR, how to avoid it? J Cardiothorac Surg 2024; 19:143. [PMID: 38504317 PMCID: PMC10949699 DOI: 10.1186/s13019-024-02615-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Coronary artery obstruction after percutaneous aortic replacement is a complication with high short-term mortality secondary to the lack of timely treatment. There are various predictors of coronary obstruction prior to valve placement such as the distance from the ostia, the degree of calcification, the distance from the sinuses; In such a situation some measures must be taken to prevent and treat coronary obstruction. CASE PRESENTATION An 84-year-old male, with severe aortic stenosis and high surgical risk, who was treated with TAVR. However, during the deployment of the valve he presented hemodynamic instability secondary to LMCA obstruction. The intravascular image showed obstruction of the ostium secondary to the displacement of calcium that he was successfully treated with a chimney stent technique. CONCLUSIONS The high degree of calcification and the left ostium near the annulus are conditions for obstruction of the ostium at the time of valve release; In this context, provisional stenting prior to TAVR in patients at high risk of obstruction should be considered as a safe prevention strategy to achieve the success of the procedure.
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Affiliation(s)
- Jose R Gayosso-Ortíz
- Interventional cardiology service, National Medical Center, November 20, Mexico City, Mexico
- Interventional cardiology service, General Hospital of Mexico, Mexico City, Mexico
| | - Juan F Garcia-Garcia
- Interventional cardiology service, National Medical Center, November 20, Mexico City, Mexico
- Interventional cardiology service, General Hospital of Mexico, Mexico City, Mexico
| | | | | | - Juan C Fuentes-Moreno
- Interventional cardiology service, National Medical Center, November 20, Mexico City, Mexico
| | | | | | - Heberto Aquino-Bruno
- Interventional cardiology service, National Medical Center, November 20, Mexico City, Mexico.
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Paredes-Vázquez JG, Tirado-Conte G, Jiménez-Quevedo P, Mon-Noboa M, Pozo E, Núñez-Gil I, Gonzalo N, Fernández-Ortiz A, Escaned J, Nombela-Franco L. Computed Tomography Analysis of Coronary Chimney Stenting Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2023:S1936-8798(23)01431-0. [PMID: 38180418 DOI: 10.1016/j.jcin.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 01/06/2024]
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Meucci F, Di Muro FM, Martinucci P, Stolcova M, Di Mario C, Cecchi E. Tunnel stent technique as an alternative treatment for left main protection in valve-in-valve transcatheter aortic valve implantation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2023; 19:371-374. [PMID: 38187483 PMCID: PMC10767559 DOI: 10.5114/aic.2023.133811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/22/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Francesco Meucci
- Structural Interventional Cardiology Division, Department of Cardiac Thoracic and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesca Maria Di Muro
- Structural Interventional Cardiology Division, Department of Cardiac Thoracic and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pietro Martinucci
- Cardiology Division, Nuovo Ospedale San Giovanni di Dio, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology Division, Department of Cardiac Thoracic and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Cardiac Thoracic and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Emanuele Cecchi
- General Cardiology Division, Department of Cardiac Thoracic and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Montarello NJ, Quagliana A, Søndergaard L, De Backer O. Leaflet modification or chimney stenting in patients at risk for coronary artery obstruction in valve-in-valve procedure for a failed surgical bioprosthetic aortic valve. Catheter Cardiovasc Interv 2023; 101:655-659. [PMID: 36651342 DOI: 10.1002/ccd.30561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/06/2022] [Accepted: 12/17/2022] [Indexed: 01/19/2023]
Abstract
Valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) for a degenerated surgical aortic bioprosthesis is a well-established treatment modality but carries an increased risk of coronary artery obstruction (CAO) with potentially catastrophic consequences. Both chimney stenting and leaflet modification by BASILICA (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Obstruction) are increasingly employed and can be highly effective means of preventing CAO. Using a case report, in which both strategies were utilized, as a platform for detailed discussion, we address the indications, contraindications, and relative merits of each technique in the prevention of CAO.
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Affiliation(s)
- Nicholas J Montarello
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Angelo Quagliana
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Bielecki MA, DeVos AN, Bianchini F, Iaizzo PA. Multimodal Imaging of a Chimney-Stenting Procedure Performed Simultaneously with a Transcatheter Aortic Valve Replacement (TAVR) in a Reanimated Human Heart including Post-Implant Analyses. J Cardiovasc Dev Dis 2022; 9:jcdd9120413. [PMID: 36547410 PMCID: PMC9788102 DOI: 10.3390/jcdd9120413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/11/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become a popular treatment option for severe aortic stenosis for patients with a high risk for mortality with surgical aortic valve replacement (SAVR). Coronary artery occlusion (CAO) following the implantation of the device is a potential and sometimes devastating complication of this procedure, that provokes a sudden deterioration of hemodynamic status followed by cardiogenic shock and electrical instability. With patients that present a high risk for coronary obstruction, coronary protection with a chimney stenting technique is an effective strategy that can ensure coronary perfusion during TAVR in case of acute CAO. Utilizing Visible Heart® methodologies, a human heart was reanimated. A chimney stenting technique was implemented simultaneously with the deployment of a Medtronic Evolut™ Pro+ valve (Medtronic PLC; Minneapolis, MN, USA). The entire procedure was recorded utilizing endoscopic cameras, fluoroscopy, optical coherence tomography, and echocardiography. In addition to these procedural visualizations, post-procedural micro-computed tomography (micro-CT) was conducted to provide post-implantation imaging with approximately 60-micron resolution. Utilizing these imaging modalities in a reanimated human heart allows for the unique opportunity to collect data for TAVR procedures in real human anatomies for the subsequent educational uses by the physicians treating aortic valvular disease and/or the designers of future TAVR technologies and procedures.
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Affiliation(s)
- Michael A. Bielecki
- Departments of Surgery and Biomedical Engineering, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
- Correspondence:
| | - Amanda N. DeVos
- Departments of Surgery and Biomedical Engineering, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Francesco Bianchini
- Cardiology, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Metropolitan City of Rome, Italy
| | - Paul A. Iaizzo
- Departments of Surgery and Biomedical Engineering, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
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Yang C, Song G, Niu G, Wu Y. Coronary protection for the small left coronary sinus during transcatheter aortic valve replacement: a case report. Eur Heart J Case Rep 2022; 6:ytac011. [PMID: 35243204 PMCID: PMC8886909 DOI: 10.1093/ehjcr/ytac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/26/2021] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
Abstract
Background Coronary obstruction (CO) is an infrequent but life-threatening complication during transcatheter aortic valve replacement (TAVR). Case summary We report the case of a patient who accepted TAVR with high anatomical risks of CO due to the small congenital left coronary sinus, which was treated with preliminary coronary protection. This case highlighted the importance of computed tomography angiography (CTA) evaluation, 3D-printing stimulation, predilation as a reference sign, and pre-emptive chimney stenting technology to successfully anticipate and prevent CO during TAVR. At the 3rd month follow-up, CTA evaluation and 3D-printing simulation identified the chimney stenting of the left main coronary arterial patency. Discussion A ‘four-step assessment’ method also proposes a new clinical procedure on how to perform TAVR in patients with high risks of CO.
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Affiliation(s)
- Chen Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Guangyuan Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Guannan Niu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
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1 Year Outcome of Chimney Snorkel Stunting Technique in Our TAVR Cohort. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Medranda GA, Rogers T. Risk and Mitigation of Coronary Obstruction in Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021; 10:481-490. [PMID: 34593111 DOI: 10.1016/j.iccl.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute coronary artery occlusion is a rare but devastating complication of transcatheter aortic valve replacement. Coronary obstruction is angiographic evidence of a new-partial or complete-obstruction of a coronary artery. Key factors identifying patients at risk are aortic root anatomy, type of aortic valve, and type of transcatheter heart valve. Techniques to prevent coronary obstruction include intentional leaflet laceration. If acute coronary obstruction does occur, bailout stenting can be challenging and conversion to emergent open heart surgery may be required, both of which are associated with high morbidity and mortality.
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Affiliation(s)
- Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B1, Washington, DC 20010, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B1, Washington, DC 20010, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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