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Updated: Jun 1, 2025
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Changes in microcirculation following transcatheter aortic valve implantation in patients with stable coronary artery
Quentin Battistolo1, Robin Le Ruz1, Pierre-Guillaume Piriou1
1Nantes Université, CHU Nantes, Unité Hémodynamique et Cardiologie Interventionnelle, l'institut du thorax, 44000 Nantes, France.
Insights
Transcatheter aortic valve implantation (TAVI) improved coronary flow reserve (CFR) in patients with coronary artery disease and severe aortic stenosis. Fractional flow reserve (FFR) remained reproducible for guiding revascularization post-TAVI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Physiology
Background:
- Coronary physiology assessment in patients with both coronary artery disease (CAD) and severe aortic stenosis (AS) is limited.
- Fractional flow reserve (FFR) validation for guiding revascularization in this specific patient group is lacking.
Purpose of the Study:
- To evaluate changes in coronary physiology before and after transcatheter aortic valve implantation (TAVI) in patients with stable CAD and severe AS.
- To assess the role of FFR in this population post-TAVI.
Main Methods:
- Prospective inclusion of 29 patients with stable CAD and severe AS undergoing TAVI between 2020-2023.
- Coronary physiology assessed pre-TAVI, immediately post-TAVI, and at a median 5.4-month follow-up.
- Measurements included FFR, transit mean time, basal microvascular resistance, and coronary flow reserve (CFR).
Main Results:
- FFR showed a slight numerical decrease post-TAVI (0.83 to 0.81).
- Coronary flow reserve (CFR) significantly improved immediately post-TAVI (1.5 to 1.9, P=0.006).
- At follow-up, the significant increase in CFR was lost, and FFR remained stable.
Conclusions:
- TAVI leads to immediate improvement in CFR in patients with CAD and severe AS.
- FFR demonstrates reproducibility after TAVI, supporting its use for revascularization guidance.
- Microvascular resistance changes warrant further investigation in this patient cohort.
Background:
Few studies have assessed coronary physiology in the setting of coronary artery disease (CAD) with severe aortic stenosis (AS). Fractional flow reserve (FFR) to guide revascularization in such patients is not validated.
Aims:
We describe changes in coronary physiology in this population before and after transcatheter aortic valve implantation (TAVI).
Methods:
Patients with stable CAD and severe AS treated with TAVI were prospectively included during 2020-2023. Coronary physiology was assessed before and immediately after TAVI, and at follow-up (median 5.4 months).
Results:
Twenty-nine patients (mean age 81.3 years) were included. Median (95% confidence interval) FFR decreased numerically, from 0.83 (0.79-0.84) pre-TAVI to 0.81 (0.78-0.83) post-TAVI. During hyperaemia, the transit mean time reduced numerically, from 0.27 (0.19-0.35) to 0.20 (0.18-0.27) seconds, reflecting increased coronary flow. Basal microvascular resistance increased numerically, from 24 (21-35) to 32 (23-45), while resistive reserve ratio increased significantly, from 1.8 (1.5-2.3) to 2.6 (2.2-3.1) (P=0.002). Consequently, coronary flow reserve (CFR) improved significantly, from 1.5 (1.2-1.7) to 1.9 (1.5-2.4) (P=0.006). Among 21 patients with follow-up, no significant change in FFR was observed and the significance of the increase in CFR was lost. Only three patients had an index of microvascular resistance>25, indicating microvascular impairment during hyperaemia.
Conclusions:
In stable CAD patients treated with TAVI for severe AS, valve replacement provides an immediate improvement in CFR. FFR shows a minimal decrease after valve implantation, supporting its reproducibility to guide revascularization in such patients.
Clinical Trial Registration:
.NCT04663334.
