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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

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Coronary access after transcatheter aortic valve replacement in bicuspid versus tricuspid aortic stenosis

Fei Chen1, Kaiyu Jia2, Yijian Li1

  • 1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|March 3, 2022
PubMed

Insights

Coronary access after transcatheter aortic valve replacement (TAVR) can be challenging. Type 0 bicuspid aortic valve (BAV) anatomy appears more favorable for post-TAVR coronary access compared to tricuspid aortic valves (TAV).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Coronary access post-transcatheter aortic valve replacement (TAVR) differences between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) anatomy are unknown.
  • Understanding these differences is crucial for procedural planning and patient outcomes.

Purpose of the Study:

  • To investigate and compare coronary access after TAVR using a self-expanding transcatheter heart valve (THV).
  • To evaluate access in patients with bicuspid aortic valves (BAV) versus tricuspid aortic valves (TAV) using computed tomography (CT) simulation.

Main Methods:

  • CT simulation analysis of 86 type 0 BAV, 70 type 1 BAV, and 132 TAV patients.
  • Defined challenging coronary access based on THV or native leaflet interference.
  • Defined complex coronary access if coaxial engagement was hindered by the unwrapped frame.

Main Results:

  • THV-related challenging coronary access occurred in 21.2% (LCA) and 17.7% (RCA).
  • Type 0 BAV patients had less THV-related challenging LCA access than TAV patients (OR 0.42).
  • Optimal fluoroscopic angles for RCA engagement were significantly higher in type 0 BAV patients.

Conclusions:

  • Coronary access can be challenging or complex in a significant number of BAV and TAV patients post-TAVR.
  • Type 0 BAV anatomy may offer a more favorable profile for post-TAVR coronary access.
Abstract

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