Impact of the en face view for coronary cannulation after transcatheter aortic valve replacement

With the increasing number of transcatheter aortic valve replacements (TAVR) performed annually, coronary cannulation in post-TAVR patients has gained importance. The aim of this study was to investigate the effectiveness of the en face view for post-TAVR coronary cannulation. Between March 2015 and March 2024, we evaluated coronary cannulation based on the period when the en face view was initiated post-TAVR in December 2021. To assess the impact of the transcatheter heart valve on cannulation success, we excluded patients whose cannulation was conducted outside the stent frame. During the study period, 82 consecutive coronary cannulations were evaluated (en face era/pre-en face era = 47/35). Balloon-expandable valves were used in 48.8% of cases, and cannulation was performed in 31.7% of cases involving acute coronary syndromes. The overall cannulation success rate was 64.6%. Notably, the success rate was significantly higher during the en face era compared to the pre-en face era (78.7% vs. 45.7%, p = 0.003). Cannulation success was more frequently achieved during the en face era in both types of prostheses (self-expandable valve: 83.3% vs. 50.0%, p = 0.049; balloon-expandable valve: 75.9% vs. 36.4%, p = 0.03). Moreover, multivariate analysis identified the en face era as an independent predictor of cannulation success (adjusted odds ratio = 4.57, 95% confidence interval = 1.37-15.30, p = 0.01). The success rate of cannulation was significantly higher during the en face era. This study suggests that the en face view enhances the success rate of coronary cannulation, regardless of the prosthesis type.