Coronary Cannulation After Transcatheter Aortic Valve Replacement: The RE-ACCESS Study

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.