An alternative solution for patient with high risk of coronary obstruction underwent TAVI procedure using a novel second-generation device \u2013 a case series

Hong Qian,Zhaoyun Cheng,Yucheng Chen,Yingqiang Guo

doi:10.1186/s13019-019-0859-1

Abstract

BackgroundObstruction of the left or right coronary artery is a rare but lethal complication during transcatheter aortic valve implantation (TAVI). The new J-Valve™ prosthesis is a new second generation TAVI device which has several features to avoid the coronary obstruction such as low profile design and clip fixation of the native leaflets. The aim of this study is to report our initial experience of using this valve in treating patient with high risk factors for coronary obstruction during TAVI procedure.Case presentationThree high surgical risk patients (All females with 77, 76, and 75 years old) with symptomatic aortic stenosis were enrolled. All patients have the common feature of low coronary ostium height (< 10 mm) with narrowed aortic sinus (< 30 mm) on CT angiogram and marked leaflet calcification. Three 25 mm J-Valve prostheses were successfully implanted through trans-apical approach. No coronary obstruction was noted for these patients. Effective aortic open area was significantly increased after valve implantation (Preoperative 0.7, 0.7 and 0.65 cm2 – Postoperative 1.8, 1.9 and 2.0 cm2). Only one patient was noted to have trivial degree paravalvular leakage.ConclusionThe new J-Valve prosthesis is a new second generation TAVI device. This system may provide another safety treatment option for patient with high risk factor for coronary obstruction underwent TAVI procedure.

Highlights

Obstruction of the left or right coronary artery is a rare but lethal complication during transcatheter aortic valve implantation (TAVI)
Obstruction of the left or right coronary ostium is a relatively rare but lethal complication during TAVI procedure, it is generally accepted that a distance between the coronary ostium and the annulus less than 10 mm or sinus of Valsalva diameter below 30 mm, and existing of bulky calcified leaflet are risks for coronary occlusion as for several type of classic TAVI devices such as Edward SAPIEN and Medtronic CoreValve [1, 2]
We reported our initial experience of using J-Valve in treating patient with high risk factor for coronary obstruction during TAVI procedure

Summary

Introduction

Obstruction of the left or right coronary artery is a rare but lethal complication during transcatheter aortic valve implantation (TAVI). Case presentation: Three high surgical risk patients (All females with 77, 76, and 75 years old) with symptomatic aortic stenosis were enrolled. Transcatheter aortic valve implantation (TAVI) has evolved as a routine procedure to treat selected high-risk patients with severe aortic stenosis. Obstruction of the left or right coronary ostium is a relatively rare but lethal complication during TAVI procedure, it is generally accepted that a distance between the coronary ostium and the annulus less than 10 mm or sinus of Valsalva diameter below 30 mm, and existing of bulky calcified leaflet are risks for coronary occlusion as for several type of classic TAVI devices such as Edward SAPIEN and Medtronic CoreValve [1, 2]. Case presentation Three high surgical risk patients with symptomatic aortic stenosis who are at high risk for coronary occlusion during TAVI procedure were enrolled (three female patients). Qian et al Journal of Cardiothoracic Surgery (2019) 14:47 Patient

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