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Cardiac Catheterization IV: Nursing Management01:26

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Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
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Cardiac Catheterization III: Left Heart Catheterization01:24

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Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
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Cardiac Catheterization II: Right Heart Catheterization01:21

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Right Heart Catheterization: An OverviewRight heart catheterization is an invasive diagnostic procedure that measures right-sided cardiac and pulmonary artery pressures, calculates cardiac output, and identifies intracardiac shunts. It provides detailed hemodynamic data essential for diagnosing and managing various cardiovascular conditions, such as pulmonary hypertension.Access SitesCommon access sites for right heart catheterization include the internal jugular vein in the neck region, the...
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Cardiac Catheterization I: Pre-Procedure Overview01:28

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Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
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Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
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Related Experiment Video

Updated: Dec 5, 2025

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Coronary Cannulation After Transcatheter Aortic Valve Replacement: The RE-ACCESS Study.

Marco Barbanti1, Giuliano Costa1, Andrea Picci1

  • 1Division of Cardiology, A.O.U. Policlinico-San Marco, Catania, Italy.

JACC. Cardiovascular Interventions
|October 18, 2020
PubMed
Summary

Coronary cannulation after transcatheter aortic valve replacement (TAVR) is feasible in most cases, but Evolut TAVs increase the risk of failure. Specific factors predict and help manage this complication.

Keywords:
TAVRaortic stenosiscannulationcoronary arteriescoronary artery disease

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Coronary ostia cannulation after transcatheter aortic valve replacement (TAVR) is crucial for managing potential complications.
  • Limited data exists on the feasibility and reproducibility of coronary cannulation post-TAVR.

Purpose of the Study:

  • To investigate the feasibility of coronary ostia cannulation after TAVR.
  • To identify predictors of impaired coronary access following TAVR.

Main Methods:

  • Prospective, single-center registry study (RE-ACCESS) of consecutive patients undergoing TAVR.
  • Coronary angiography performed before and after TAVR.
  • Primary endpoint: rate of unsuccessful coronary ostia cannulation post-TAVR; Secondary endpoints: factors associated with cannulation failure.

Main Results:

  • Unsuccessful coronary cannulation occurred in 7.7% of 300 patients.
  • Evolut R/PRO transcatheter aortic valves (TAVs) were associated with 17.9% failure rate versus 0.4% for other TAVs (p < 0.01).
  • Independent predictors of failure included Evolut TAV use, TAV-sinus of Valsalva relation, and TAV implantation depth.

Conclusions:

  • Unsuccessful coronary cannulation post-TAVR is infrequent but significantly higher with Evolut TAVs.
  • A predictive model combining Evolut TAV use, sinus relation, and implantation depth accurately identifies patients at risk.
  • These findings aid in anticipating and managing coronary access challenges after TAVR.