Cargando…
Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up
Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is emerging as an effective treatment for patients with symptomatically failing bioprosthetic valves and a high prohibitive surgical risk; a longer life expectancy has led to a higher demand for these valve reinterventions due to the...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10219453/ https://www.ncbi.nlm.nih.gov/pubmed/37233154 http://dx.doi.org/10.3390/jcdd10050187 |
_version_ | 1785049013842608128 |
---|---|
author | Prandi, Francesca Romana Niv Granot, Yoav Margonato, Davide Belli, Martina Illuminato, Federica Vinayak, Manish Barillà, Francesco Romeo, Francesco Tang, Gilbert H. L. Sharma, Samin Kini, Annapoorna Lerakis, Stamatios |
author_facet | Prandi, Francesca Romana Niv Granot, Yoav Margonato, Davide Belli, Martina Illuminato, Federica Vinayak, Manish Barillà, Francesco Romeo, Francesco Tang, Gilbert H. L. Sharma, Samin Kini, Annapoorna Lerakis, Stamatios |
author_sort | Prandi, Francesca Romana |
collection | PubMed |
description | Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is emerging as an effective treatment for patients with symptomatically failing bioprosthetic valves and a high prohibitive surgical risk; a longer life expectancy has led to a higher demand for these valve reinterventions due to the increased possibilities of outliving the bioprosthetic valve’s durability. Coronary obstruction is the most feared complication of valve-in-valve (ViV) TAVR; it is a rare but life-threatening complication and occurs most frequently at the left coronary artery ostium. Accurate pre-procedural planning, mainly based on cardiac computed tomography, is crucial to determining the feasibility of a ViV TAVR and to assessing the anticipated risk of a coronary obstruction and the eventual need for coronary protection measures. Intraprocedurally, the aortic root and a selective coronary angiography are useful for evaluating the anatomic relationship between the aortic valve and coronary ostia; transesophageal echocardiographic real-time monitoring of the coronary flow with a color Doppler and pulsed-wave Doppler is a valuable tool that allows for a determination of real-time coronary patency and the detection of asymptomatic coronary obstructions. Because of the risk of developing a delayed coronary obstruction, the close postprocedural monitoring of patients at a high risk of developing coronary obstructions is advisable. CT simulations of ViV TAVR, 3D printing models, and fusion imaging represent the future directions that may help provide a personalized lifetime strategy and tailored approach for each patient, potentially minimizing complications and improving outcomes. |
format | Online Article Text |
id | pubmed-10219453 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-102194532023-05-27 Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up Prandi, Francesca Romana Niv Granot, Yoav Margonato, Davide Belli, Martina Illuminato, Federica Vinayak, Manish Barillà, Francesco Romeo, Francesco Tang, Gilbert H. L. Sharma, Samin Kini, Annapoorna Lerakis, Stamatios J Cardiovasc Dev Dis Review Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is emerging as an effective treatment for patients with symptomatically failing bioprosthetic valves and a high prohibitive surgical risk; a longer life expectancy has led to a higher demand for these valve reinterventions due to the increased possibilities of outliving the bioprosthetic valve’s durability. Coronary obstruction is the most feared complication of valve-in-valve (ViV) TAVR; it is a rare but life-threatening complication and occurs most frequently at the left coronary artery ostium. Accurate pre-procedural planning, mainly based on cardiac computed tomography, is crucial to determining the feasibility of a ViV TAVR and to assessing the anticipated risk of a coronary obstruction and the eventual need for coronary protection measures. Intraprocedurally, the aortic root and a selective coronary angiography are useful for evaluating the anatomic relationship between the aortic valve and coronary ostia; transesophageal echocardiographic real-time monitoring of the coronary flow with a color Doppler and pulsed-wave Doppler is a valuable tool that allows for a determination of real-time coronary patency and the detection of asymptomatic coronary obstructions. Because of the risk of developing a delayed coronary obstruction, the close postprocedural monitoring of patients at a high risk of developing coronary obstructions is advisable. CT simulations of ViV TAVR, 3D printing models, and fusion imaging represent the future directions that may help provide a personalized lifetime strategy and tailored approach for each patient, potentially minimizing complications and improving outcomes. MDPI 2023-04-23 /pmc/articles/PMC10219453/ /pubmed/37233154 http://dx.doi.org/10.3390/jcdd10050187 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Prandi, Francesca Romana Niv Granot, Yoav Margonato, Davide Belli, Martina Illuminato, Federica Vinayak, Manish Barillà, Francesco Romeo, Francesco Tang, Gilbert H. L. Sharma, Samin Kini, Annapoorna Lerakis, Stamatios Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up |
title | Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up |
title_full | Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up |
title_fullStr | Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up |
title_full_unstemmed | Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up |
title_short | Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up |
title_sort | coronary obstruction during valve-in-valve transcatheter aortic valve replacement: pre-procedural risk evaluation, intra-procedural monitoring, and follow-up |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10219453/ https://www.ncbi.nlm.nih.gov/pubmed/37233154 http://dx.doi.org/10.3390/jcdd10050187 |
work_keys_str_mv | AT prandifrancescaromana coronaryobstructionduringvalveinvalvetranscatheteraorticvalvereplacementpreproceduralriskevaluationintraproceduralmonitoringandfollowup AT nivgranotyoav coronaryobstructionduringvalveinvalvetranscatheteraorticvalvereplacementpreproceduralriskevaluationintraproceduralmonitoringandfollowup AT margonatodavide coronaryobstructionduringvalveinvalvetranscatheteraorticvalvereplacementpreproceduralriskevaluationintraproceduralmonitoringandfollowup AT bellimartina coronaryobstructionduringvalveinvalvetranscatheteraorticvalvereplacementpreproceduralriskevaluationintraproceduralmonitoringandfollowup AT illuminatofederica coronaryobstructionduringvalveinvalvetranscatheteraorticvalvereplacementpreproceduralriskevaluationintraproceduralmonitoringandfollowup AT vinayakmanish coronaryobstructionduringvalveinvalvetranscatheteraorticvalvereplacementpreproceduralriskevaluationintraproceduralmonitoringandfollowup AT barillafrancesco coronaryobstructionduringvalveinvalvetranscatheteraorticvalvereplacementpreproceduralriskevaluationintraproceduralmonitoringandfollowup AT romeofrancesco coronaryobstructionduringvalveinvalvetranscatheteraorticvalvereplacementpreproceduralriskevaluationintraproceduralmonitoringandfollowup AT tanggilberthl coronaryobstructionduringvalveinvalvetranscatheteraorticvalvereplacementpreproceduralriskevaluationintraproceduralmonitoringandfollowup AT sharmasamin coronaryobstructionduringvalveinvalvetranscatheteraorticvalvereplacementpreproceduralriskevaluationintraproceduralmonitoringandfollowup AT kiniannapoorna coronaryobstructionduringvalveinvalvetranscatheteraorticvalvereplacementpreproceduralriskevaluationintraproceduralmonitoringandfollowup AT lerakisstamatios coronaryobstructionduringvalveinvalvetranscatheteraorticvalvereplacementpreproceduralriskevaluationintraproceduralmonitoringandfollowup |