Transcatheter aortic valve implantation (TAVI) has become the main treatment for elderly patients with middle and high risk aortic stenosis. However, coronary artery occlusion (CAO) related to TAVI is a very serious complication, which often leads to poor prognosis. Therefore, active preoperative prevention is particularly important. Preoperative computed tomography evaluation, bioprosthetic or native aortic scallop intentional laceration and chimney stent implantation technology can prevent TAVI-related coronary orifice obstruction. Ensuring commissural alignment during operation can reduce the occurrence of coronary occlusion, but its long-term prognosis needs further study. In addition, percutaneous coronary intervention is the main treatment, but there are problems such as difficult coronary access after TAVI. This article summarized the research progress in the mechanism, prevention and treatment of CAO related to TAVI.
An 84-year-old severe aortic stenosis patient admitted with acute heart failure was reported. Transcatheter aortic valve replacement (TAVR) was proposed. The patient was at high risk of the left coronary artery occlusion in preoperative and intraoperative evaluation. Coronary artery protection was performed by pre-embedded coronary artery guide wire and stent during the TAVR. The left coronary artery was partially blocked by valve leaflet after 23 mm self-expanding aortic valve was released. Coronary revascularization was not performed as the coronary blood flow was not affected. However, the patient suffered acute myocardial infarction with hypotension on the third day after TAVR. Emergency angiography showed that left coronary artery was more blocked than before and the condition improved after left main coronary stent implantation. This case suggested that aggressive coronary revascularization should be considered for high risk of coronary artery obstruction during TAVR, especially for partial obstruction of coronary artery.