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August 15, 2026Journal of the American College of Cardiology

Predictive Factors, Management, and Clinical Outcomes of Coronary Obstruction Following Transcatheter Aortic Valve Implantation

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Why the study?

Very little data existed on coronary obstruction following transcatheter aortic valve implantation.

What are the predictive factors, management, and clinical outcomes of coronary obstruction following TAVI?

Population

44 patients with symptomatic coronary obstruction out of 6,688 undergoing TAVI

Comparison

Coronary obstruction patients vs control group of 345 patients

Design

Multicenter registry

Follow-up

Median 12 (2 to 18) months

Key result

Symptomatic coronary obstruction following TAVI was associated with lower-lying coronary ostia (10.6 vs 13.4 mm; p<0.001) and carried a 30-day mortality of 40.9%.

Authors

HRHenrique Barbosa RibeiroJWJohn G. WebbRMRaj Makkar

Discussion

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Member takes

Overview

May support pre-TAVI CT screening of coronary height; leaves open prospective trials of prevention before practice change.

Key Points

  • To determine the baseline characteristics, anatomical risk factors, procedural management, and clinical outcomes associated with coronary obstruction following transcatheter aortic valve implantation.
  • Multicenter registry analyzing 44 patients with symptomatic coronary obstruction among 6,688 individuals undergoing transcatheter aortic valve implantation (0.66%).
  • Pre-procedural computed tomography scans in 28 obstructed cases were compared against 345 controls (including a 1:1 matched cohort) with a median follow-up of 12 months (range 2 to 18 months).
  • Coronary obstruction was significantly associated with older age (p < 0.001), female sex (p < 0.001), absence of previous coronary bypass (p = 0.043), balloon-expandable valves (p = 0.023), and prior surgical bioprostheses (p = 0.045).
  • Obstruction cases featured lower left coronary ostium height (10.6 ± 2.1 mm vs. 13.4 ± 2.1 mm, p < 0.001) and smaller sinus of Valsalva diameter (28.1 ± 3.8 mm vs. 31.9 ± 4.1 mm, p < 0.001).
  • Percutaneous coronary intervention was attempted in 75.0% of patients and succeeded in 81.8%, but 30-day mortality reached 40.9% and cumulative 12-month mortality reached 45.5%.

Study Design

Type

Cohort (n=6,688)

Multicenter

Yes

Structured PICO

What are the predictive factors, management, and clinical outcomes of coronary obstruction following TAVI?

P
Population
6,688 patients undergoing transcatheter aortic valve implantation, including 44 who suffered symptomatic coronary obstruction, followed for a median of 12 months.
E
Exposure
Transcatheter aortic valve implantation (TAVI)
C
Comparator
Patients without coronary obstruction (control group)
O
Outcome
Baseline and procedural characteristics, management, and clinical outcomes (including 30-day and late mortality) of coronary obstructionsafety

Main Result

Absolute Event Rate: 10.6% vs 13.4%

p-value: p=<0.001

Symptomatic coronary obstruction following TAVI is a rare (0.66%) but life-threatening complication associated with lower-lying coronary ostia, shallow sinus of Valsalva, female sex, and balloon-expandable valves, carrying a very high mortality rate despite successful treatment.

Cite This Study

Ribeiro et al. (2013) conducted a cohort in Transcatheter aortic valve implantation (n=6,688). Coronary obstruction vs. No coronary obstruction was evaluated on Mean left coronary artery ostia height (p=<0.001). Symptomatic coronary obstruction following TAVI was associated with lower-lying coronary ostia (10.6 vs 13.4 mm; p<0.001) and carried a 30-day mortality of 40.9%.

synapsesocial.com/papers/6a80509890df07fd7ab3b505https://doi.org/10.1016/j.jacc.2013.07.040
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