%0 Journal Article
%T Left Main Protection During Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve.
%A Hsiung I
%A Spilias N
%A Bazarbashi N
%A Ahuja KR
%A Patel J
%A Kaur S
%A Rossi J
%A Gad M
%A Abdelfattah O
%A Saad A
%A Popovic Z
%A Miyasaka R
%A Yun J
%A Weiss A
%A Unai S
%A Puri R
%A Reed G
%A Krishnaswamy A
%A Kapadia SR
%J J Soc Cardiovasc Angiogr Interv
%V 1
%N 4
%D 2022 Jul-Aug
%M 39131930
暂无%R 10.1016/j.jscai.2022.100339
%X <B>UNASSIGNED: </B>Coronary obstruction during transcatheter aortic valve replacement (TAVR) is a rare, yet life-threatening, complication. The routine use of left main (LM) protection with or without stent placement in high-risk patients remains controversial. The aim of this study was to evaluate the outcomes of LM protection during TAVR and identify anatomic factors associated with need for stent placement.<BR><B>UNASSIGNED: </B>We retrospectively reviewed all TAVR cases (native and valve-in-valve) performed in our institution between 2014 and 2019 and identified patients who underwent LM protection with a coronary wire, balloon, and/or stent during the procedure. We compared the pre-TAVR computed tomography aortic root characteristics, procedural data, short-, and long-term outcomes among the patients who eventually received an LM stent and those who did not.<BR><B>UNASSIGNED: </B>Among 1925 TAVR patients, 41 (2.1%) underwent LM protection, and 10 of them (25%) had eventually a stent placed in the LM for threatened obstruction after valve deployment. In the native TAVR group (n = 35), 8 patients underwent LM stenting. A larger TAVR prosthesis, larger annular circumference (83.8 vs 76.1 ​mm; P = .038), lower ratio of sinotubular junction diameter to prosthesis size (1.02 vs 1.11; P = .032), and longer left coronary cusp (15.1 vs 13.9 ​mm; P = .18) were associated with higher incidence of LM stenting. In the valve-in-valve TAVR group (n = 6), 5 patients had a valve-to-coronary distance of less than 4 ​mm, and 2 of them received an LM stent. Both stent and nonstent groups had excellent outcomes with no major adverse cardiovascular events or coronary obstruction at 30 ​days. After a median follow-up of 351 ​days, 4 patients died (9.7%) (1 in the stent and 3 in the nonstent group), without any cases of late coronary obstruction or percutaneous coronary intervention in either group.<BR><B>UNASSIGNED: </B>LM protection with a coronary guidewire, balloon, or stent is a safe and effective method of coronary protection during TAVR in appropriately selected high-risk patients. Annular circumference, prosthesis size, left coronary cusp length, LM ostial height, and ratio of sinotubular junction to prosthesis size are important predictors of stent deployment.