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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

Insights

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.

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.
Abstract

Keywords:
TAVRaortic stenosiscannulationcoronary arteriescoronary artery disease

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