Coronary Access After Repeated Transcatheter Aortic Valve Implantation

Buzzatti, Nicola; Romano, Vittorio; Backer, Ole De; Soendergaard, Lars; Rosseel, Liesbeth; Maurovich-Horvat, Pál; Karády, Júlia; Merkely, Béla; Ruggeri, Stefania; Prendergast, Bernard; Bonis, Michele De; Colombo, Antonio; Montorfano, Matteo; Latib, Azeem

doi:10.1016/j.jcmg.2019.06.025

Cited by 49 publications

(25 citation statements)

References 2 publications

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“…Coronary : While normally access to the coronary arteries after TAVI is maintained through the stent which is ‘free-flow’, in the case of TAVI-in-TAVI the new prosthesis will stretch and squeeze the flaps of the previous device along its stent, covering it and preventing coronary catheters from crossing it. This mechanism can compromise both perfusion and access to the coronary arteries, but the exact prevalence of the problem remains to be clarified, 13 depending on both the size of the native aorta and the device implanted first.…”

Section: First Tavi Results In Patients <75 Years Of Agementioning

confidence: 99%

Severe aortic stenosis in the young, with or without bicuspid valve: is transcatheter aortic valve implantation the first choice?

Belluschi

Buzzatti

Castiglioni

et al. 2020

European Heart Journal Supplements

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During the last decade, transcatheter aortic valve implantation (TAVI) has represented a valid alternative to surgical aortic valve replacement in patients with aortic stenosis and elevated surgical risk. Recent randomized clinical trials reported excellent results also for patients at low surgical risk, but in clinical practice, the mean age of the patients treated remain over 75 years, and the presence of a bicuspid aortic valve still represents an important exclusion criteria. Today, aortic valve replacement with a mechanical prosthesis remains the treatment of choice for young adults with aortic stenosis, although the desire to avoid oral anticoagulants drives more patients younger than 65 years of age towards biological prostheses. Furthermore, despite the follow-up of patients after TAVI is still limited to a few years, the opportunity of a second percutaneous treatment (TAVI-in-TAVI), extends the scope of percutaneous strategy. In the next few years, TAVI has to face many challenges to become a valid alternative to surgery in the younger patients as well.

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Section: First Tavi Results In Patients <75 Years Of Agementioning

confidence: 99%

Severe aortic stenosis in the young, with or without bicuspid valve: is transcatheter aortic valve implantation the first choice?

Belluschi

Buzzatti

Castiglioni

et al. 2020

European Heart Journal Supplements

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View full text Add to dashboard Cite

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“…The surgical literature has shown that younger patients have accelerated prosthetic valve degeneration compared to their older counterparts. Therefore, we need to consider initial TAVR orientation as TAVR-in-TAVR increases in prominence (3). By paying attention to how we deploy valves now, we can help the implanters of the future provide optimal patient care.…”

Section: Discussionmentioning

confidence: 99%

“…As transcatheter aortic valve replacement (TAVR) evolves across the spectrum of younger and low-risk patients, the issue of transcatheter heart valve (THV) orientation during initial deployment is becoming increasingly more important. Lack of commissural alignment may lead to varying degrees of overlap between the neo-commissural posts and coronary arteries, thus disrupting laminar coronary flow and jeopardizing the success of redo-TAVR and coronary re-access procedures (1)(2)(3)(4)(5). Furthermore, THV leaflet stress and central aortic regurgitation may theoretically be exacerbated with suboptimal commissural alignment (6,7).…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve replacement aortic root orientation: implications for future coronary access and redo transcatheter aortic valve replacement

Alexis¹,

Zaid²,

Sengupta³

et al. 2020

Ann Cardiothorac Surg

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“…The self-expansion TAVI has a higher skirt and smaller open cell size than the balloon expansion TAVI thus producing a greater risk of restricting the access to coronary ostia (Fig. 10) [107]. In the case of TAVI valvein-valve for those who had first time TAVI implant, unfeasible coronary access occurs in over 30% of patients [108].…”

Section: Is Tavi Ready For the Prime Time In Low Risk And Younger As Patients?mentioning

confidence: 99%

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement

Jin

Petrou

et al. 2021

Front. Med.

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Over the last half century, surgical aortic valve replacement (SAVR) has evolved to offer a durable and efficient valve haemodynamically, with low procedural complications that allows favourable remodelling of left ventricular (LV) structure and function. The latter has become more challenging among elderly patients, particularly following trans-catheter aortic valve implantation (TAVI). Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss, valvular-vascular impedance to myocardial activation, force-velocity relationship, and myocardial strain. LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour. Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome. Physiological pacing via the His-Purkinje system for conduction abnormalities, further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression, LV coordinate contraction, and global vascular function. TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions. Until comparable long-term durability and the resolution of TAVI related complications become available, SAVR remains the first choice for lower risk younger patients.

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Coronary Access After Repeated Transcatheter Aortic Valve Implantation

Cited by 49 publications

References 2 publications

Severe aortic stenosis in the young, with or without bicuspid valve: is transcatheter aortic valve implantation the first choice?

Severe aortic stenosis in the young, with or without bicuspid valve: is transcatheter aortic valve implantation the first choice?

Transcatheter aortic valve replacement aortic root orientation: implications for future coronary access and redo transcatheter aortic valve replacement

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement

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