Author + information
- 1University of Michigan Health Center, Ann Arbor, Michigan, United States
- 2Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, United States
- 3University of Southern California, Los Angeles, California, United States
- 4Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- 5Medtronic, Saint Paul, Minnesota, United States
Approximately 80% of patients who underwent attempted self-expanding transcatheter aortic valve replacement (TAVR) in the CoreValve US Trial Program (Pivotal and Continued Access Study [CAS]) had coronary artery disease. As the use of TAVR is being studied in lower-risk patients, the ability to access the coronary vasculature is important for long-term patient management.
Adverse event records for patients in the CoreValve US Trial Program were scanned to identify patients who had undergone diagnostic or therapeutic coronary angiography following TAVR. Data extraction included events through August 4, 2015. PCI data were not collected a priori, therefore we performed a retrospective review of the adverse event database using the following search terms; percutaneous intervention, angio, PCI, stent, cath, BMS, DES, and coronary. Unsuccessful PCI included not able to cannulate the target vessel or cross the lesion.
Of 3741 patients with an implanted CoreValve bioprothesis, 169 patients underwent 190 post implantation coronary angiography diagnostic studies of at least 1 coronary vessel. Baseline characteristics include; mean age=80.4±7.7 yrs, 61.5% male, mean STS=8.5±4.9%, BMI=27.9±5.8 kg/m2, previous MI=48.2%, prior CABG=52.7%, prior PCI=66.3%, diabetes=50.9% and stage 4/5 chronic kidney disease = 11.3%. In 12 cases, only 1 vessel was injected because it was the target lesion or the other vessel had a known 100% stenosis. Access was not possible in 4 studies (2.1%) in 4 patients (2.4%). Of the 186 successful angiographic studies, 113 underwent attempted PCI; 103 were successful (91.2%). A total of 247 stents, angioplasty balloons and miscellaneous other interventional devices were successfully delivered through the TAV.
Diagnostic and interventional coronary catheterization was possible in nearly all patients in whom it was indicated. Best practices and technical suggestions to help achieve a positive outcome will be presented at the time of the meeting.
STRUCTURAL: Valvular Disease: Aortic