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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

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Incidence and feasibility of coronary access after transcatheter aortic valve replacement

Luca Nai Fovino1, Andrea Scotti1, Mauro Massussi1

  • 1Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|January 9, 2020
PubMed

Insights

Coronary access after transcatheter aortic valve replacement (TAVR) is uncommon long-term. Coronary access and intervention (PCI) are generally safe and successful post-TAVR, though supra-annular devices may pose challenges.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Long-term incidence of coronary access (CA) following transcatheter aortic valve replacement (TAVR) is not well-established.
  • Coronary interventions post-TAVR may encounter technical difficulties, especially with supra-annular valve deployment.

Purpose of the Study:

  • To determine the incidence, feasibility, and outcomes of coronary access after TAVR.
  • To identify predictors of coronary access post-TAVR.
  • To assess the safety and success rates of percutaneous coronary intervention (PCI) after TAVR.

Main Methods:

  • Retrospective analysis of 912 patients who underwent TAVR between 2007 and 2018.
  • Inclusion criteria: patients undergoing CA post-TAVR (excluding in-TAVR coronary obstruction).
  • Data collected: incidence, procedural success, outcomes, and predictors of CA.

Main Results:

  • The incidence of CA post-TAVR was 5.3% (48/912 patients) at a median follow-up of 769 days.
  • PCI was indicated in 54% of cases, with 35% for acute coronary syndromes (ACS).
  • Coronary access was feasible in all intra-annular device cases, but not in two supra-annular valve cases; PCI success rate was 98%.
  • Younger age, prior PCI, and prior CABG were predictors of CA post-TAVR.

Conclusions:

  • Coronary access post-TAVR in high-risk aortic stenosis patients is infrequent.
  • Coronary access and PCI are safe and effective procedures after TAVR.
  • Supra-annular valve placement may be associated with a reduced rate of selective coronary access.
Abstract

Keywords:
coronary accesscoronary artery diseasepercutaneous coronary interventiontranscatheter aortic valve replacement

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