Incidence and feasibility of coronary access after transcatheter aortic valve replacement

Fovino, Luca Nai; Scotti, Andrea; Massussi, Mauro; Fabris, Tommaso; Cardaioli, Francesco; Rodinò, Giulio; Matsuda, Yuji; Frigo, F.; Fraccaro, Chiara; Tarantini, Giuseppe

doi:10.1002/ccd.28720

Cited by 50 publications

(30 citation statements)

References 30 publications

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“…Unique design characteristics of the type of transcatheter aortic valve (TAV) must also be considered when developing a strategy to engage the coronary arteries. Numerous trials demonstrate the feasibility of coronary angiography and intervention post-TAVR (14-23), but with consistently lower reported success rates following implantation of the Medtronic CoreValve (Medtronic Inc., Minneapolis, MN, USA), especially of the right coronary artery (RCA) (14,17,19,21,22). In the current paper, we review valve deployment strategies to optimize re-access to the coronary arteries, focusing on valve-in-valve procedures, as well as technique and catheter selection to aid in successful post-TAVR angiography and intervention.…”

Section: Coronary Artery Disease and Aortic Stenosismentioning

confidence: 99%

Overcoming the transcatheter aortic valve replacement Achilles heel: coronary re-access

Arshi

Yakubov

Stiver

et al. 2020

Ann Cardiothorac Surg

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Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for the treatment of symptomatic severe aortic stenosis (AS). Coronary artery disease (CAD) is common in patients with severe AS. As the indications for TAVR extend to lower risk patients with longer life expectancy and as CAD is a progressive condition, coronary angiography will become increasingly common in patients who have had a previous TAVR. Coronary artery re-access after TAVR may be challenging but is possible in most cases. Commissural alignment of the prosthesis with the native coronary ostia plays an important role in successful coronary re-access. Coronary artery obstruction is a potentially devastating complication of TAVR, particularly in valve-in-valve procedures. In the present keynote lecture, we review techniques used to mitigate the risk of coronary obstruction, as well as catheter selection and strategies for selective coronary artery engagement for specific transcatheter aortic valve (TAV) bioprostheses.

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Section: Coronary Artery Disease and Aortic Stenosismentioning

confidence: 99%

Overcoming the transcatheter aortic valve replacement Achilles heel: coronary re-access

Arshi

Yakubov

Stiver

et al. 2020

Ann Cardiothorac Surg

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“…Until the results of these RCTs or other strong scientific evidences about the need and timing of PCI in TAVR candidates will not be available, a case by case decision by the Heart Valve Team is to be pursued, taking into account the individual patient's anatomic, clinical, and physiological characteristics, and considering also the different feasibility and failure rate in coronary access among different transcatheter valve types 5 …”

Section: Figurementioning

confidence: 99%

Aortic valve replacement plus revascularization: The battle of surgical versus transcatheter approach still rages

Tarantini

Fraccaro

2020

Cathet Cardio Intervent

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Key Points The current guidelines for primary aortic valve disease suggest, with different class of recommendation, concomitant coronary artery revascularization in all candidates to aortic valve replacement with angiographic evidence of significant coronary artery diameter stenosis (≥70%, ≥50% for left main stenosis) both for surgical or transcatheter approach. Initial (non‐patient‐level) pooled data analyses suggest that a percutaneous transcatheter approach confers similar outcomes compared to a surgical approach in patients with severe AS and CAD. Further scientific evidences from RCTs are warranted to clarify the prognostic impact of CAD on TAVR candidates and to identify the most appropriate revascularization strategy.

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“… 8 Moreover, some evidence suggests that CA feasibility after TAVI may differ with different THV designs. 8 – 11 …”

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confidence: 99%

Coronary Access and Percutaneous Coronary Intervention Up to 3 Years After Transcatheter Aortic Valve Implantation With a Balloon-Expandable Valve

Tarantini

Fovino

Prince

et al. 2020

Circ: Cardiovascular Interventions

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Background: Coronary artery disease and aortic stenosis often coexist. Transcatheter aortic valve implantation (TAVI) has emerged as a valid therapeutic option for younger, lower-risk patients who may eventually require coronary artery disease treatment. Thus, post-TAVI coronary access (CA) and percutaneous coronary intervention are expected to increase. The purpose of this study was to retrospectively evaluate patients who were enrolled in the SOURCE 3 (SAPIEN 3 Aortic Bioprosthesis European Outcome) European registry for treatment with the balloon-expandable SAPIEN 3 transcatheter heart valve and underwent CA with or without percutaneous coronary intervention after TAVI. Methods: Baseline characteristics and clinical outcomes of patients with or without CA up to 3 years after TAVI were compared. A Kaplan-Meier estimate with a univariate model determined the impact of CA on cardiac mortality. Results: Of 1936 TAVI patients (mean age 81.6 years, 52% male), 68 (3.5%) had CA within 3 years (mean 441±332 days) after TAVI. At baseline, the logistic EuroSCORE was similar (20.2% versus 18.3%, P =0.2, CA and non-CA groups, respectively). Higher rates of coronary artery disease (76.5% versus 50.6%, P <0.001), myocardial infarction (20.6% versus 11.5%, P =0.03) and previous coronary artery bypass graft (22.1% versus 11.0%, P =0.01) were present in the CA group. In 100% of patients, CA was successfully achieved. The clinical success of percutaneous coronary intervention was 97.9%. Cardiovascular mortality was numerically higher in patients with CA than in those without CA. Conclusions: In the large SOURCE 3 European registry, CA was needed at 3-year follow-up after TAVI with a balloon-expandable valve in 3.5% of patients and was successful in all patients. The clinical success of percutaneous coronary intervention was 97.9%. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02698956.

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Incidence and feasibility of coronary access after transcatheter aortic valve replacement

Cited by 50 publications

References 30 publications

Overcoming the transcatheter aortic valve replacement Achilles heel: coronary re-access

Overcoming the transcatheter aortic valve replacement Achilles heel: coronary re-access

Aortic valve replacement plus revascularization: The battle of surgical versus transcatheter approach still rages

Coronary Access and Percutaneous Coronary Intervention Up to 3 Years After Transcatheter Aortic Valve Implantation With a Balloon-Expandable Valve

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