Coronary Risk in Transcatheter Aortic Valve Replacement, Overview of Data, Challenges, and Best Practices

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Technology

Background:

• Coronary artery obstruction is a rare but significant complication following transcatheter aortic valve replacement (TAVR).
• The risk of obstruction is notably higher in TAVR-valve-in-valve procedures.
• Anatomic risk factors for coronary occlusion can be identified using cardiac computed tomography scans.

Purpose of the Study:

• To review the evolution of strategies for managing coronary artery obstruction post-TAVR.
• To evaluate the efficacy and limitations of current and emerging preventive techniques.

Main Methods:

• Review of existing literature on TAVR-related coronary artery obstruction.
• Analysis of historical and recent preventive and therapeutic approaches.
• Discussion of anatomical risk factors identified via computed tomography.

Main Results:

• Rescue percutaneous coronary intervention (PCI) was an early treatment but associated with high mortality.
• Preventive chimney stenting is effective but may impede future coronary access.
• Novel preventive techniques like Basilica and Shortcut are under investigation.

Conclusions:

• Coronary artery obstruction post-TAVR requires careful risk assessment and management.
• Preventive strategies are evolving to mitigate risks while preserving future coronary access.
• Ongoing research into new techniques aims to enhance safety and efficacy in TAVR procedures.