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Updated: Oct 27, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Feasibility of Coronary Access in Patients With Acute Coronary Syndrome and Previous TAVR
Won-Keun Kim1, Costanza Pellegrini2, Sebastian Ludwig3
1Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany; Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany.
Insights
Coronary angiography and intervention after transcatheter aortic valve replacement are feasible, though long stent frames may complicate access. Diabetes, shock, and failed PCI predict mortality post-procedure.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Coronary access can be challenging after transcatheter aortic valve replacement (TAVR).
- Difficulties in coronary access during acute cardiovascular events post-TAVR can have severe outcomes.
- Evaluating the safety and efficacy of coronary procedures in this patient group is crucial.
Purpose of the Study:
- To assess the feasibility of coronary angiography (CA) and percutaneous coronary intervention (PCI) in acute settings for patients with prior TAVR.
- To identify potential challenges and success rates of these procedures post-TAVR.
Main Methods:
- Retrospective analysis of an international registry.
- Inclusion of 449 patients from 25 sites who underwent urgent or emergent CA after TAVR.
- Data collection focused on acute coronary syndromes and other acute cardiovascular situations.
Main Results:
- High success rates for CA of both right (98.3%) and left (99.3%) coronary arteries.
- CA success for the right coronary artery was higher with short stent-frame prostheses (SFPs) compared to long SFPs (99.6% vs 95.9%).
- Percutaneous coronary intervention (PCI) of native coronary arteries was successful in 91.4% of cases, irrespective of valve type.
Conclusions:
- Coronary angiography and PCI are generally successful in acute settings post-TAVR.
- Long stent-frame prostheses may present challenges for selective coronary engagement.
- Independent predictors of 30-day mortality after PCI include prior diabetes, cardiogenic shock, and failed PCI.
Objectives:
The aim of this study was to characterize the feasibility of coronary angiography (CA) and percutaneous coronary intervention (PCI) in acute settings among patients who have undergone transcatheter aortic valve replacement (TAVR).
Background:
Impaired coronary access after TAVR may be challenging and particularly in acute settings could have deleterious consequences.
Methods:
In this international registry, data from patients with prior TAVR requiring urgent or emergent CA were retrospectively collected. A total of 449 patients from 25 sites with acute coronary syndromes (89.1%) and other acute cardiovascular situations (10.9%) were included.
Results:
Success rates were high for CA of the right coronary artery (98.3%) and left coronary artery (99.3%) and were higher among patients with short stent-frame prostheses (SFPs) than in those with long SFPs for CA of the right coronary artery (99.6% vs 95.9%; P = 0.005) but not for CA of the left coronary artery (99.7% vs 98.7%; P = 0.24). PCI of native coronary arteries was successful in 91.4% of cases and independent of valve type (short SFP 90.4% vs long SFP 93.4%; P = 0.44). Guide engagement failed in 6 patients, of whom 3 underwent emergent coronary artery bypass grafting and another 3 died in the hospital. Among patients requiring revascularization of native vessels, independent predictors of 30-day all-cause mortality were prior diabetes, cardiogenic shock, and failed PCI but not valve type or success of coronary engagement.
Conclusions:
CA or PCI after TAVR in acute settings is usually successful, but selective coronary engagement may be more challenging in the presence of long SFPs. Among patients requiring PCI, prior diabetes, cardiogenic shock, and failed PCI were predictors of early mortality.
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