Complexity assessment and technical aspect of coronary angiogram and percutaneous coronary intervention following transcatheter aortic valve implantation

Abstract

Background Performing selective coronary angiogram (CA) and percutaneous coronary intervention (PCI) post transcatheter aortic valve implantation (TAVI) may be challenging with various success rates of coronary ostia engagement. Methods Among all patients who underwent CA and/or PCI after TAVI from our single center TAVI registry, ostia cannulation success was reported according to the quality of ostia engagement and artery opacification, and was classified as either selective, partially selective or non-selective but sufficient for diagnosis. Results Among the 424 consecutive TAVI procedures performed at the aforementioned institution, 20 (4.7%) CA were performed in 19 (4.5%) patients at a median time of 464 days post TAVI (25–75% IQ: 213–634 days). CA were performed in 7 CoreValve, 9 Evolut R, 1 Evolut PRO and 2 Edwards Sapien 3 devices. Transradial vascular approach was attempted in 9 procedures (45%, right n = 6 and left n = 3) and was successful in 8 (40%) patients. A total of 20 left main artery ostium cannulation were attempted leading to a diagnostic CA in all of them with selective engagement in 65%. Engagement of the right coronary artery in 2 out of 15 attempted cases failed due to a low ostium in conjunction with a high implantation of a CoreValve prosthesis. 11 PCI (55% of CA) including 2 left main lesions were performed. In 4 patients (36.4% of the PCI), an extension catheter was required to engage the left main. All planned PCI were successful. Conclusions Post TAVI CA and PCI are challenging but feasible even after supra-annular self-expandable valve implantation.

Percutaneous Coronary Intervention in Transcatheter Aortic Valve Implantation Patients: Overview and Practical Management

“…A higher residual SS after PCI before or during TAVI had a significant impact on the primary endpoint (14). In contrast, Paradis et al found no difference in the composite endpoint of all-cause mortality, myocardial infarction, and stroke after 30 days or 1 year between CAD patients stratified according to low (≤22), intermediate (21)(22)(23)(24)(25)(26)(27)(28)(29)(30), and high (≥33) SS and patients without CAD undergoing TAVI (13). Finally, the largest study with a multicenter design included 1,270 patients who were stratified into three groups according to their pre-TAVI status: no CAD, non-severe CAD (SS < 22), or severe CAD (SS ≥ 22); those undergoing PCI were further subdivided into "reasonably" incomplete revascularization with a residual SS < 8 and "incomplete" revascularization with a rSS of >8 (31).…”

“…To date, little data exists on the incidence of CA and/or PCI after TAVI outside the periprocedural setting, as a result of ACS, CCS, or other reasons, particularly with respect to long-term follow-up. In the mostly single-center studies available in the literature, the incidence of CA in TAVI patients ranges between 2.5 and 5.3%, with PCI performed in 27–55% of cases ( 28 – 30 , 33 – 35 ) ( Table 2 ). According to Nai Fovino et al, the frequency of CA post-TAVI during a follow-up period of 2.1 years was 5.3% in a single-center cohort comprising 912 patients ( 30 ).…”

“…In addition, a small balloon (e.g., 2.0/12 mm) can be positioned in the left main to guide the catheter in (balloon-assisted tracking). The balloon can also be carefully inflated in a more peripheral position in the coronary vessel to further “pull” the catheter into the ostium (anchoring balloon technique) ( 28 ). Of course, care should be taken during this maneuver to avoid dissections.…”

Coronary Computed Tomographic Angiography Often Allows for the Avoidance of Invasive Coronary Angiography Before Transcatheter Aortic Valve Implantation

“…Post-TAVI PCI can be challenging depending on the type of valve. 8 The self-expanding valves covering the coronary ostia may require more skill to re-access the coronary ostium. Commissure alignment technique may partially reduce the technical challenges.…”

Updates on the Role of Interventional Radiology in Ischemic Patients Undergoing Aortic Valve Replacement: Systematic Review

“…A total of 6252 patients were included. Five studies were conducted in the USA (Jeroudi et al, 2018;Guedeney et al, 2019;Abugroun et al, 2020;Ghrair et al, 2020;Tran et al, 2022), two in Switzerland (Winter et al, 2021;Perrin et al, 2022), two in France (Denimal et al, 2021;Matta et al, 2021), one in Japan (Kaihara et al, 2021), and one in Canada (Ferreira-Neto et al, 2019). Table 2 presents the characteristics of the included studies.…”