经导管主动脉瓣置换术围术期冠状动脉闭塞的评估和处理流程Perioperative evaluation and management of coronary obstruction in transcatheter aortic valve replacement
范嘉祺,刘先宝,艾丽菲热·艾合买提,陈俊,戴晗怡,周道,何宇欣,朱齐丰,郭宇超,王力涵,林心平,蒋巨波,任凯达,胡泼,王建安
摘要(Abstract):
随着经导管主动脉瓣置换术手术数量的指数增长、适应证向年轻患者扩展,更加需要关注围术期冠状动脉情况。急性冠状动脉闭塞是一种相对少见但危急生命的并发症。本文通过术前CT血管造影图像,综合考虑瓣叶弯曲长度、窦垂直高度、窦管交界处和有效窦宽度,评估冠状动脉闭塞的风险。对于冠状动脉高风险的患者,可以进行球囊预扩张、实行冠状动脉保护、BASILICA等方式进行术中评估或预防。采用多个临床案例阐述了该冠状动脉闭塞评估方法的可行性和有效性。
关键词(KeyWords): 经导管主动脉瓣置换术;冠状动脉闭塞;主动脉瓣狭窄
基金项目(Foundation):
作者(Author): 范嘉祺,刘先宝,艾丽菲热·艾合买提,陈俊,戴晗怡,周道,何宇欣,朱齐丰,郭宇超,王力涵,林心平,蒋巨波,任凯达,胡泼,王建安
参考文献(References):
- [1]Avvedimento M,Tang GHL.Transcatheter aortic valve replacement(TAVR):recent updates[J].Prog Cardiovasc Dis,2021,69:73-83.DOI:10.1016/j.pcad.2021.11.003.
- [2]Price J,Bob-manuel T,Aymond J,et al.Low risk TAVR:long-term considerations and appropriate patient selection[J].Prog Cardiovasc Dis,2020,63(3):377-382.DOI:10.1016/j.pcad.2020.04.002.
- [3] Genereux P,Piazza N,Alu MC,et al.Valve academic research consortium 3:updated endpoint definitions for aortic valve clinical research[J].Eur Heart J,2021,42(19):1825-1857.DOI:10.1093/eurheartj/ehaa799.
- [4]Ribeiro HB,Nombela-franco L,Urena M,et al.Coronary obstruction following transcatheter aortic valve implantation:a systematic review[J].JACC Cardiovasc Interv,2013,6(5):452-461.DOI:10.1016/j.jcin.2012.11.014.
- [5]Yamamoto M,Shimura T,Kano S,et al.Impact of preparatory coronary protection in patients at high anatomical risk of acute coronary obstruction during transcatheter aortic valve implantation[J].Intern J Cardiol,2016,217:58-63.DOI:10.1016/j.ijcard.2016.04.185.
- [6] Khan JM,Dvir D,Greenbaum AB,et al.Trans catheter laceration of aortic leaflets to prevent coronary obstruction during transcatheter aortic valve replacement:concept to first-in-human[J].JACC Cardiovasc Interv,2018,11(7):677-689.DOI:10.1016/j.jcin.2018.01.247.
- [7]Khan JM,Kamioka N,Lisko JC,et al.Coronary obstruction from tavr in native aortic stenosis:development and validation of multivariate prediction model[J].JACC Cardiovasc Interv,2023,16(4):415-425.DOI:10.1016/j.jcin.2022.11.018.
- [8]Webb JG.Coronary obstruction due to transcatheter valve implantation[J].Catheter Cardiovasc Interv,2009,73(7):973.DOI:10.1002/ccd.22105.
- [9]Valvo R,Costa G,Barbanti M.How to avoid coronary occlusion during TAVR valve-in-valve procedures[J].Front Cardiovasc Med,2019,6:168.DOI:10.3389/fcvm.2019.00168.
- [10] Ribeiro HB,Rodes-cabau J,Blanke P,et al.Incidence,predictors,and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves:insights from the VIVID registry[J].Eur Heart J,2018,39(8):687-695.DOI:10.1093/eurheartj/ehx455.
- [11] Ribeiro HB,Webb JG,Makkar RR,et al.Predictive factors,management,and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation[J].J Am Coll Cardiol,2013,62(17):1552-1562.DOI:10.1016/j.jacc.2013.07.040.
- [12]Arshi A,Yakubov SJ,Stiver KL,et al.Overcoming the transcatheter aortic valve replacement Achilles heel:coronary re-access[J].Ann Cardiothorac Surg,2020,9(6):468-477.DOI:10.210 3 7/acs-2020-av-3 8.
- [13]Tarantini G,Tang G,Nai Fovino L,et al.Management of coronary artery disease in patients undergoing transcatheter aortic valve implantation.A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions in collaboration with the ESC Working Group on Cardiovascular Surgery[J].EuroIntervention,2023,19(1):37-52.DOI:10.4244/EIJ-D-22-00958.
- [14]Dvir D,Leipsic J,Blanke P,et al.Coronary obstruction in transcatheter aortic valve-in-valve implantation:preprocedural evaluation,device selection,protection,and treatment[J].Circ Cardiovasc Interv,2015,8(1):e002079.DOI:10.1161/CIRCINTERVENTIONS.114.002079.
- [15]Heitkemper M,Hatoum H,Azimian A,et al.Modeling risk of coronary obstruction during transcatheter aortic valve replacement[J].J Thorac Cardiovasc Surg,2020,159(3):829-838.DOI:10.1016/j.jtcvs.2019.04.091.
- [16]Abramowitz Y,Chakravarty T,Jilaihawi H,et al.Clinical impact of coronary protection during transcatheter aortic valve implantation:first reported series of patients[J].EuroIntervention,2015,11(5):572-581.DOI:10.4244/EIJV11I5A112.
- [17] Tagliari AP,Petersen Saadi R,Medronha EF,et al.The use of BASILICA technique to prevent coronary obstruction in a TAVI-TAVI procedure[J].J Clin Med,2021,10(23):5534.DOI:10.3390/jcm10235534.
- [18]Kitamura M,Majunke N,Holzhey D,et al.Systematic use of intentional leaflet laceration to prevent TAVIinduced coronary obstruction:feasibility and early clinical outcomes of the BASILICA technique[J].EuroIntervention,2020,16(8):682-690.DOI:10.4244/EIJ-D-20-00386.
- [19]Khan JM,Greenbaum AB,Babaliaros VC,et al.The BASILICA trial:prospective multicenter investigation of intentional leaflet laceration to prevent TAVR coronary obstruction[J].JACC Cardiovasc Interv,2019,12(13):1240-1252.DOI:10.1016/j.jcin.2019.03.035.
- [20] Lederman RJ,Babaliaros VC,Rogers T,et al.Preventing coronary obstruction during transcatheter aortic valve replacement:from computed tomography to BASILICA[J].JACC Cardiovasc Interv,2019,12(13):1197-1216.DOI:10.1016/j.jcin.2019.04.052.
- [21]Mercanti F,Rosseel L,Neylon A,et al.Chimney stenting for coronary occlusion during TAVR:insights from the chimney registry[J].JACC Cardiovasc Interv,2020,13(6):751-761.DOI:10.1016/j.j cin.2020.01.227.
- [22]Hashimoto N,Tamura H,Otaki Y,et al.Perfusion balloon is useful for preventing obstruction of left main coronary artery during transcatheter aortic valve implantation[J].Int Heart J,2022,63(1):163-167.DOI:10.1536/ihj.21-275
- [23]Oh JH,Kobayashi Y,Kang G,et al.Distance between valvular leaflet and coronary ostium predicting risk of coronary obstruction during TAVR[J].Int J Cardiol Heart Vase,2021,37:100917.DOI:10.1016/j.ijcha.2021.100917.
- [24]Blanke P,Soon J,Dvir D,et al.Computed tomography assessment for transcatheter aortic valve in valve implantation:the vancouver approach to predict anatomical risk for coronary obstruction and other considerations[J].J Cardiovasc Comput Tomogr,2016,10(6):491-499.DOI:10.1016/j.jcct.2016.09.004.