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Updated: Aug 30, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Long-term risk of unplanned percutaneous coronary intervention after transcatheter aortic valve replacement
Taishi Okuno1, Caglayan Demirel1, Daijiro Tomii1
1Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
Insights
The lifetime risk of unplanned percutaneous coronary intervention (PCI) after transcatheter aortic valve replacement (TAVR) is low for patients with no coronary artery disease (CAD). However, the risk increases over time for those with pre-existing CAD, especially multivessel disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Structural Heart Disease
Background:
- Transcatheter aortic valve replacement (TAVR) can present challenges for subsequent coronary access and percutaneous coronary intervention (PCI).
- Understanding the incidence and predictors of unplanned PCI post-TAVR is crucial for patient management.
Purpose of the Study:
- To determine the incidence, characteristics, and predictors of unplanned PCI following TAVR.
- To assess the long-term risk of unplanned PCI based on pre-existing coronary artery disease (CAD) status.
Main Methods:
- A single-center registry prospectively collected data on 3,015 TAVR patients.
- Coronary angiography was performed before TAVR to screen for CAD.
- Unplanned PCI rates were monitored and adjudicated.
Main Results:
- 2.2% (67 patients) underwent unplanned PCI post-TAVR, most commonly for acute coronary syndrome.
- Patients undergoing unplanned PCI were younger and more likely male.
- Multivariable analysis identified number of diseased vessels, male sex, and younger age as predictors of unplanned PCI.
Conclusions:
- The cumulative incidence of unplanned PCI after TAVR is low in patients without CAD but rises over time in those with single or multivessel CAD.
- Patients with multivessel CAD face a significantly higher lifetime risk of unplanned PCI post-TAVR.
Background:
Coronary access after transcatheter aortic valve replacement (TAVR) can be challenging and complicate percutaneous coronary intervention (PCI).
Aims:
We aimed to investigate the incidence, characteristics, and predictors of unplanned PCI after TAVR.
Methods:
In a single-centre registry, TAVR candidates were systematically screened for concomitant coronary artery disease (CAD) through the use of coronary angiography prior to TAVR. Rates of unplanned PCI were prospectively collected and independently adjudicated.
Results:
Among 3,015 patients undergoing TAVR between August 2007 and December 2020, 67 patients (2.2%) underwent unplanned PCI after TAVR. The indication for unplanned PCI was acute coronary syndrome in more than half of the cases. Patients with unplanned PCI were younger (80.2±6.5 years vs 81.9±6.4 years; p=0.028) and more likely to be male (75% vs 50%; p<0.001) than those without unplanned PCI. In a multivariable analysis, the number of diseased vessels, male sex, and younger age were independently associated with an increased risk of unplanned PCI. The cumulative incidence rates of unplanned PCI at 1, 5, and 10 years were 0.1%, 0.4%, and 0.6% in patients with no CAD at the time of TAVR, 0.7%, 2.5%, and 3.4% in patients with single-vessel disease, and 1.5%, 5.4%, and 7.4% in patients with multivessel disease, respectively.
Conclusions:
The lifetime risk of unplanned PCI after TAVR is low in patients with no CAD at the time of TAVR but accumulates over time in patients with known CAD, particularly multivessel disease.
Clinicaltrials:
gov: NCT01368250.
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