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Coronory artery abnormalities in patients undergoing transcutaneous aortic valve replacment (tavi)

Author: 
Laith Obaidat, Sakher Sharaa, Ola M Alwaqfi, Yazan Bani Hamad, Moath Marashdeh
Subject Area: 
Health Sciences
Abstract: 

Introduction: Transcutanous aortic valve implantation (TAVI) is being increasingly done nowadays in lower risk patients, and these patients will commonly have major coronary abnormalities needing intervension around the time of TAVI. Objectives: to identify the prevalence of coronary artery abnormalities in patients undergoing TAVI and management options. Methods: this is a retrospective study of patients who underwent TAVI from Jan. 2016 till May 2021 at Queen Alia Military heart institute in Jordan. Demographic data where reviewed including age, co-morbidities, gender, signs and symptoms, echo findings, results of computed tomography or angiography before and during the procedure and complications after the procedure. Results: thirty four patients were included, age 50-91 years (average 77.5 years). All patients were symptomatic before TAVI. 7 patient had diabetes, 15 patients had hypertension, three patients had previous coronary artery disease, two patients had chronic kidney disease, three patients had previous malignancy, two patients had atrial fibrillation and one patient had previous pacemaker implanted 9 patient had impaired LV function. all patients had severe aortic senosis and in six patients there was associated moderate to severe aortic regurgitation. In 10 patients there were significant coronary artery lesions. all patients were stented. the average number of stents was 1.6 Stents per patient. All stents were drug eluting stents (DES). there was associated mild disease in four patients. three patients had previous CABG; two of them were stented. six patients died after the procedure. complications including SVG oclusion which was stented. Pericardial effusion in three patients and in one patient there was tamponade needing drainage. one patient had complete heart block for whom a permanent pacemaker was inserted. femoral artery dissection happened in three patients and all were stented. one patient had 2:1 AV block and one patient had coronory CCU psychosis. Conclusion: major coronary abnormalitites happen in one thirds of TAVI and these must be addressed during or before TAVI. The timing and best management option should be addressed

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