Coronary access after TAVR with the 4th and 5th -generation self-expanding Evolut valves: The EPROMPT-CA study

As transcatheter aortic valve replacement (TAVR) expands to lower-risk patients, optimizing post-TAVR coronary access and identifying its determinants have become increasingly important.

To evaluate coronary access and assess CT predictors of selective access post-TAVR with the Evolut FX/FX+ valves.

This single-center, prospective study enrolled patients undergoing transfemoral TAVR with Evolut FX/FX+ valves. Coronary access was attempted immediately post-deployment, with CT performed at 30-60 days. The primary endpoint was coronary access success. CTs were analyzed for predictors of access success.

A total of 143 patients (103 FX, 40 FX+) were enrolled; post-TAVR CT was completed in 76 (55 FX, 21 FX+). Coronary access was successful in 95.1 % of left coronary artery (LCA) and 83 % of right coronary artery (RCA) attempts. Success rates were similar between FX and FX+, but FX+ required less contrast (5.45 vs. 8.92 mL; p < 0.001) and fewer catheters (1.13 vs. 1.32; p = 0.014) for LCA. Access determinants differed by artery: LCA access was primarily associated with ostial position relative to the aortic cusp and transcatheter heart valve frame, while RCA access was mainly influenced by larger aortic root and valve dimensions. Commissural and coronary alignment were not associated with selective access. None of the identified associations reliably predicted selective coronary access, and subjective predictions by CT readers were also inaccurate.

Post-TAVR coronary access using Evolut FX/FX+ valves was more frequently successful for the LCA than the RCA. The FX+ valve facilitated coronary access with reduced procedural effort. CT identified distinct anatomical determinants for LCA versus RCA access. However, CT-derived analyses did not reliably predict coronary access success.