Real world coronary artery ostia full accessibility after last generation transcatheter aortic valve implantation

We evaluate, performing a pooled meta-analysis, the current coronary artery accessibility rate in transcatheter aortic valve implantation (TAVI) patients during the follow-up. Full coronary artery accessibility after TAVI has not been adequately addressed by the current literature.

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, data on coronary artery access were obtained from the ratio between in the full coronary engagement (n) and the number of coronary angiography and/or percutaneous coronary intervention (N). Data were synthesized using random-effects meta-analyses.

Out of 7048 TAVI patients, 276 (3.9%) (mean age 76.8 years, 111 (40.2%) females) were analysed. Full coronary artery accessibility for coronary angiographies and percutaneous coronary interventions were obtained in 83.0% (95% confidence interval (CI): 0.66-0.92, p = 0.001, I²: 88.2%) and 96.0% (95% CI: 0.90-0.98, p < 0.0001, I²: 0) of cases (p for difference  < .0.001). Left coronary artery (n = 219) was easily fully engaged compared to the right one (90.9% (95% CI: 0.80-0.96, p < 0.0001, I²: 58.4% and 82.0% (95% CI: 0.60-0.93, p = 0.006, I²: 83.2%), respectively, (p for difference  < 0.001). Using age as moderator variable, meta-regression revealed a positive and negative correlation with coronary artery accessibility in patients treated with Sapien-Edwards (p = 0.008) and CoreValve (p = 0.010) platforms, respectively. Conversely, a negative correlation (p = 0.01) was found between coronary artery accessibility and mean time after Sapien-Edwards platform implantation (p = 0.01).

Full coronary artery accessibility during coronary angiographies and/or percutaneous coronary interventions results suboptimal for both coronary artery ostia and worse for right compared to left coronary artery after TAVI.