Left Main Protection During Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve

BackgroundCoronary obstruction during transcatheter aortic valve replacement (TAVR) is a rare, yet life-threatening, complication. The routine use of left main (LM) protection with or without stent placement in high-risk patients remains controversial. aim this study was to evaluate the outcomes LM TAVR and identify anatomic factors associated need for placement.MethodsWe retrospectively reviewed all cases (native valve-in-valve) performed our institution between 2014 2019 identified who underwent coronary wire, balloon, and/or procedure. We compared pre-TAVR computed tomography root characteristics, procedural data, short-, long-term among eventually received an those did not.ResultsAmong 1925 patients, 41 (2.1%) protection, 10 them (25%) had placed threatened after deployment. In native group (n = 35), 8 stenting. A larger prosthesis, annular circumference (83.8 vs 76.1 ​mm; P .038), lower ratio sinotubular junction diameter prosthesis size (1.02 1.11; .032), longer cusp (15.1 13.9 .18) were higher incidence valve-in-valve 6), 5 valve-to-coronary distance less than 4 ​mm, 2 stent. Both nonstent groups excellent no major adverse cardiovascular events at 30 ​days. After median follow-up 351 ​days, died (9.7%) (1 3 group), any late percutaneous intervention either group.ConclusionsLM guidewire, safe effective method appropriately selected patients. Annular circumference, size, length, ostial height, are important predictors