Assessment of coronary cannulation after TAVI with the Evolut FX valve: the CANNULATE TAVR EXPANDED study

The new-generation supra-annular, self-expanding Evolut FX system has the potential to facilitate commissural alignment.

We sought to assess the feasibility of coronary cannulation (CC) and the impact of commissural and coronary alignment on CC execution, as confirmed by post-transcatheter aortic valve implantation (TAVI) computed tomography (CT).

The CANNULATE TAVR EXPANDED study is a multicentre, prospective study which included consecutive patients who underwent transfemoral TAVI with the Evolut FX, CC, and angiography after valve deployment. Post-TAVI CT was performed to assess commissural and coronary alignment. Moderate-to-severe commissural and coronary misalignments based on the ALIGN-TAVR Consortium definition were categorised as the misalignment group. The primary endpoint was the rate of successful CC after Evolut FX implantation.

A total of 126 patients were included. CC was successful in 100% of cases for the left coronary artery (LCA) and 96.7% for the right coronary artery (RCA). Moderate-to-severe commissural misalignment was observed in 13.5%, and moderate-to-severe coronary misalignment was observed in 20.6% (LCA) and 22.2% (RCA). Misaligned LCA and RCA required significantly longer CC times. In multivariable analysis, factors associated with suboptimal LCA cannulation were coronary height (odds ratio [OR] 0.73, 95% confidence interval [CI]: 0.57-0.90; p=0.006) and coronary misalignment (OR 4.58, 95% CI: 1.45-14.47; p=0.009), whereas right coronary cusp width (OR 0.63, 95% CI: 0.44-0.90; p=0.007) and coronary misalignment (OR 4.64, 95% CI: 1.29-16.74; p=0.019) were identified for the RCA.

High rates of CC, and commissural and coronary alignment post-TAVI with the Evolut FX were observed in this prospective, multicentre study. Coronary misalignment was identified as the strongest predictor of suboptimal CC for both the LCA and the RCA.