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Coronary angiography following transcatheter aortic valve replacement: Insights from the SWEDEHEART registry

Antros Louca1,2, Monér Alchay2, Truls Råmunddal1,2

  • 1Department of Molecular and Clinical Medicine, Gothenburg University, Sweden.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|July 31, 2024
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) is common for severe aortic stenosis. Unplanned coronary angiography post-TAVR is low but higher in younger patients with coronary artery disease, influencing future device selection.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Transcatheter aortic valve replacement (TAVR) is the standard treatment for symptomatic severe aortic stenosis (AS).
  • Coronary artery disease frequently coexists with AS, making post-TAVR coronary access a critical consideration.

Purpose of the Study:

  • To determine the incidence and risk factors for unplanned coronary angiography after TAVR.
  • To assess coronary artery cannulation complexity using fluoroscopic time as a surrogate measure.

Main Methods:

  • Analysis of 9806 patients who underwent TAVR in Sweden (2008-2022) using the SWEDEHEART registry.
  • Cumulative incidence of post-TAVR coronary angiography calculated with mortality as a competing risk.
  • Fluoroscopic time used to compare angiography and PCI complexity across different transcatheter heart valve designs.

Main Results:

  • 566 patients (5.8%) required subsequent coronary angiography.
  • Higher incidence observed in patients with three-vessel and/or left main disease.
  • Younger age, extensive prior coronary artery disease, and peripheral vascular disease were risk factors for angiography. Fluoroscopy times were longer in TAVR patients, particularly with supra-annular and self-expanding valves.

Conclusions:

  • The rate of coronary angiography after TAVR remains low.
  • Younger patients and those with existing coronary artery disease face increased risk.
  • Facilitating coronary access is crucial for device selection in TAVR patients with longer life expectancies.
Abstract

Keywords:
TAVRaortic regurgitationaortic stenosiscoronary artery disease

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