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Transcatheter Aortic Valve Replacement Influence on Coronary Hemodynamics: A Quantitative Meta-Analysis and Proposed
Rafail A Kotronias, Roberto Scarsini, Skanda Rajasundaram
1Oxford Heart Centre, John Radcliffe Hospital, Headley Way, OX3 7BA, Oxford, United Kingdom. Adrian.Banning@ouh.nhs.uk.
The Journal of Invasive Cardiology
|November 15, 2019
Summary
Transcatheter aortic valve replacement (TAVR) does not significantly alter coronary physiology measurements like coronary flow reserve or fractional flow reserve in patients with severe aortic stenosis. This suggests TAVR is safe for coronary arteries, but more data is needed on individual lesion variations.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Physiology
Background:
- Transcatheter aortic valve replacement (TAVR) is increasingly used in younger, lower-risk patients with severe aortic stenosis.
- Optimizing coronary artery disease treatment is crucial for long-term outcomes in these patients.
- Coronary physiology-guided revascularization strategies are under investigation.
Purpose of the Study:
- To investigate the influence of TAVR on coronary physiology measurements.
- To utilize quantitative meta-analytic methods to synthesize existing data.
Main Methods:
- A systematic search of Medline and Embase databases was conducted.
- Studies measuring coronary physiology indices before and after TAVR were included.
- Random-effects models were used to pool mean differences in coronary hemodynamic indices.
Main Results:
- Analysis of 5 studies (169 patients, 250 vessels) showed no significant change in coronary flow reserve in non-diseased vessels post-TAVR.
- Fractional flow reserve remained stable in both non-diseased and diseased coronary arteries after TAVR.
- Instantaneous wave-free ratio also showed no significant variation following TAVR.
Conclusions:
- Pooled data indicate that TAVR does not significantly alter overall coronary physiology measurements.
- Further research is needed to understand variations within individual coronary lesions post-TAVR.
