Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jan 14.
doi: 10.1002/ccd.30540. Online ahead of print.

Transcatheter aortic valve implantation in patients with anomalous coronary artery

Vilhelmas Bajoras  1   2 , Laurynas Diečkus  1 , Ivan Wong  3 , Anna Laurinavičienė  1 , Giedrius Davidavičius  1   2 , Sigitas Čėsna  1   2
Affiliations
Review

Transcatheter aortic valve implantation in patients with anomalous coronary artery

Vilhelmas Bajoras et al. Catheter Cardiovasc Interv. .

Abstract

Objectives: The aim of this review was to analyze literature and provide systematic algorithm to guide decision making during TAVI procedure.

Background: Transcatheter aortic valve implantation (TAVI) is growing in popularity and expanding to younger patients with lower risk profiles. Currently, there is no concise guideline on the management strategy during TAVI in patients with anomalous coronary artery (ACA) anatomy undergoing this procedure.

Methods: A systematic search was conducted for relevant case reports of TAVI in patients who had confirmed ACA anatomy. Twenty-four case reports, that met the criteria for this review, were identified and included in the final study size.

Results: TAVI was successful in 23 out of 24 cases. Half of the cases (12) described performing balloon aortic valvuloplasty (BAV) before TAVI. The majority (15) reported using angiogram Postimplantation. Only one-third of cases (8) reported performing coronary protection (with either wire, wire and stent or wire and balloon). Two-third of case reports (16/24, 67%) mentioned using Edwards SAPIEN balloon expandable transcatheter heart valves (THV).

Conclusions: Preprocedural diagnostic imaging tests play important role in determining the ACA anatomy and its relation to the aortic valve. BAV with simultaneous coronary arteries angiography or aortography should be performed before implantation of THV, as it could potentially predict whether the ACA would be compressed. Using at least a coronary wire for ACA protection is recommended in case there is high risk of ACA obstruction. Management strategy should be individualized when performing TAVI in patients with ACA.

Keywords: anomalous left coronary artery; aortic valve disease; transcatheter aortic valve replacement.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Arora S, Misenheimer JA, Ramaraj R. Transcatheter aortic valve replacement: comprehensive review and present status. Tex Heart Inst J. 2017;44(1):29-38.
    1. Maor E, Barbash IM. TAVR review of reviews: a new view on the horizon. Int J Cardiol. 2020;318(2020):43-44. doi:10.1016/j.ijcard.2020.05.075
    1. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;(18):1695-1705.
    1. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380(18):1706-1715.
    1. Bekeredjian R, Szabo G, Balaban Ü, et al. Patients at low surgical risk as defined by the Society of Thoracic Surgeons Score undergoing isolated interventional or surgical aortic valve implantation: in-hospital data and 1-year results from the German Aortic Valve Registry (GARY). Eur Heart J. 2019;40(17):1323-1330.

LinkOut - more resources