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Updated: Jun 9, 2025

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
06:59

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation

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Incidence, Predictors, and Outcomes of Unplanned Coronary Angiography After Transcatheter Aortic Valve Replacement

Asa Phichaphop1, Atsushi Okada2, Miho Fukui3

  • 1Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

JACC. Cardiovascular Interventions
|October 25, 2024
PubMed

Insights

Unplanned coronary angiography after transcatheter aortic valve replacement (TAVR) affects about 1 in 15 patients, often within the first year. Pre-existing coronary artery disease (CAD) is the strongest predictor, necessitating comprehensive management strategies.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary artery disease (CAD) assessment is crucial for severe aortic stenosis management.
  • Unplanned coronary angiography post-transcatheter aortic valve replacement (TAVR) poses clinical challenges.

Purpose of the Study:

  • To determine the incidence, predictors, and outcomes of unplanned coronary angiography following TAVR.
  • To develop a predictive model for unplanned post-TAVR angiography.

Main Methods:

  • Retrospective analysis of 1,444 TAVR procedures (July 2015 - December 2021).
  • Evaluation of unplanned angiography occurrence and percutaneous coronary intervention success.
  • Development of a machine learning prediction model for unplanned angiography.

Main Results:

  • 6.7% of patients (1 in 15) underwent unplanned post-TAVR angiography, with 45% occurring within the first year.
  • Acute coronary syndrome was the most common indication (3.3%).
  • Pre-existing CAD (50.1%) was the strongest predictor (10.5% vs 2.9% incidence; P < 0.001). Age, mean aortic valve gradient, and dialysis were also significant predictors.

Conclusions:

  • Unplanned angiography post-TAVR is relatively common, particularly in patients with pre-existing CAD.
  • A significant proportion occurs within the first year, often due to acute coronary syndrome.
  • A comprehensive strategy is needed for lifetime CAD management in TAVR candidates at risk.
Abstract

Keywords:
aortic stenosiscoronary artery diseasetranscatheter aortic valve replacementunplanned coronary angiography

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