China Structure Week 2021 丨 Professor Li Fei: Beware of the fatal complication of TAVR surgery - coronary artery obstruction

Click above the blue word "International Cycle" to follow us,

Then click on the "..." menu in the upper right corner and select ""

Editor's note: Coronary artery occlusion after transcatheter aortic valve replacement (TAVR) surgery is a life-threatening complication with high surgical and short-term mortality. At the scene of China Structure Week 2021 and the Fifth China International Structural Cardiology Conference, the reporter of this magazine specially invited to interview Professor Li Fei of Xijing Hospital affiliated to the Air Force Military Medical University on the issues related to coronary artery obstruction, and the interview content is as follows.

Video loading...

International Circulation: Coronary artery obstruction is a serious and life-threatening complication of TAVR. So, how to do a good job in coronary artery obstruction prevention when implementing TAVR in clinical practice? What emergency treatment should be done once discovered?

Professor Li Fei: The incidence of coronary artery obstruction is not high, but it is a very fatal intraoperative and postoperative complication of TAVR. Once it occurs, the mortality rate and the incidence of postoperative cardiovascular adverse events are very high. For coronary artery obstruction, it must be prevention-oriented.

How to prevent coronary artery obstruction? First of all, we must be familiar with the relevant factors of coronary artery obstruction, such as the height of the coronary opening, the size of the French sinus, the height of stJ, the length and morphology of the valve leaf, and the type and size of the implanted valve, which are all issues that need to be carefully considered. In general, coronary openings < 12 mm, French sinuses smaller than 30 mm, lobes that are too long and clumpy calcifications, and biological valve decay in the valve are all risk factors for coronary blockage. If the risk of coronary artery obstruction is too high, IT is recommended to abandon TAVR surgery.

In TAVR, balloon dilation can be observed in patients at high risk of coronary artery obstruction, and contrast can be performed during the dilation process to simulate the effect of valve implantation on the coronary opening, which is what we often call baloon sizing. To observe coronary blockage, we generally choose the coronary tangential position, the left crown opening we can choose the left shoulder position, and the right crown selects the left anterior oblique position. For patients with high coronary artery obstruction, the valve selection should not be too large when implanting the self-expanding valve, and the position is not easy to be too high. In the face of patients at high risk of coronary artery obstruction, the current view is that coronary protection should be active, we implant stents or subcaters in the coronary veins in advance, and once occlusion occurs, chimney stent technology can be used immediately to avoid acute coronary occlusion. In addition, after TAVR surgery, we should carefully evaluate the effect of prosthetic valves on coronary arteries for patients with high risk factors for coronary obstruction, and strengthen monitoring after surgery, because some patients may have delayed coronary obstruction.

The International Cycle

What important advances have been made in the field of coronary occlusion prevention in TAVR in recent years?

Professor Li Fei: The biggest progress in the prevention of coronary artery obstruction is the improvement of people's understanding of the phenomenon of coronary artery obstruction and risk factors. After years of research, we have a clear understanding of the high risk factors for coronary artery obstruction. At present, some software such as FEops, 3D printing technology, etc. have some predictive value for coronary artery obstruction. The biological mid-valve valve is one of the high-risk factors for coronary blockage, and the leaflet cutting technique (BACILICA) can now cut the original biological valve to avoid coronary blockage.

Li Fei is the deputy director of the Department of Cardiology, doctoral supervisor, professor and chief physician of the Xijing Hospital affiliated to the Air Force Military Medical University.

He is a member of the Structural Group of the Cardiovascular Branch of the Chinese Medical Association, a member of the Structural Group of the Cardiovascular Branch of the Chinese Medical Doctor Association, the director general of the Cardiovascular Branch of the Shaanxi Medical Doctor Association, the golden member of the Asia-Pacific Structural Cardiology Youth Club, and the leader of the Structural Cardiology Group of the Shaanxi Medical Doctor Association. It was the first to carry out transcatheter aortic valve replacement and transcatheter mitral valve clamping in the northwest region. The project leader presided over 4 national natural science foundations, the first or corresponding author published more than 20 papers in international journals such as Eur heart J and Diabetes, and obtained 6 national invention and utility model patents.