September 25, 2013Circulation Cardiovascular Interventions234 citations
View Full PaperRisk of Coronary Artery Compression Among Patients Referred for Transcatheter Pulmonary Valve Implantation
Key Result
Coronary artery compression was observed in 5% of patients during test balloon angioplasty for potential transcatheter pulmonary valve implantation, and was associated with abnormal coronary anatomy.
Study Design
Type
Observational (n=404)
Multicenter
Yes
Structured PICO
What is the risk of coronary artery compression among patients referred for transcatheter pulmonary valve implantation?
P
Population
404 patients (median age 18 years) undergoing catheterization for potential transcatheter pulmonary valve implantation across 4 centers.
E
Exposure
Preimplantation coronary angiography with simultaneous test balloon angioplasty of the right ventricular outflow tract
O
Outcome
Evidence of coronary artery compression during test balloon angioplastysafety
Coronary artery compression occurs in 5% of patients evaluated for transcatheter pulmonary valve implantation, highlighting the critical importance of preimplantation coronary angiography with simultaneous test angioplasty, especially in patients with abnormal coronary anatomy.
Abstract
BACKGROUND: The Melody transcatheter pulmonary valve (TPV) was approved for implantation in obstructed right ventricular outflow tract conduits in 2010 after a multicenter trial demonstrating improvements in conduit obstruction, regurgitation, and right ventricular pressure. A recognized risk and contraindication to TPV implantation is the demonstration of coronary artery (CA) compression during balloon angioplasty or stent placement in the overlying conduit. This study is the first to characterize the risk of CA compression in this population. METHODS AND RESULTS: From 2007 to 2012, 404 patients underwent 407 catheterizations for potential TPV implantation (median age, 18 years) at 4 centers. Three hundred forty-three patients (85%) underwent valve implantation. Twenty-one patients (5%) had evidence of CA compression with simultaneous right ventricular outflow tract angioplasty and CA angiography. Sixty-eight patients (17%) had abnormal CA anatomy. Fifteen of 21 (71%) patients with CA compression had abnormal CA anatomy. Eight patients with tetralogy of Fallot and 7 patients with transposition of the great arteries demonstrated compression. Of the 34 patients with tetralogy of Fallot and abnormal CA, 7 (21%) demonstrated CA compression. CONCLUSIONS: CA compression following TPV implantation can be catastrophic. CA compression was observed in 5% of patients during test balloon angioplasty. No patients in this study developed clinically apparent CA compression after TPV implantation. CA compression was significantly associated with the presence of abnormal CA anatomy, especially in patients with tetralogy of Fallot or transposition of the great arteries. Preimplantation coronary angiography with simultaneous test angioplasty is an important step to evaluate for the presence of CA compression during TPV implantation.