Author + information
- Akihito Tanaka1,
- Richard Jabbour2,
- Marianna Adamo3,
- Giuseppe Bruschi4,
- Anna Sonia Petronio5,
- Marco Barbanti6,
- Corrado Tamburino7,
- Bernhard Reimers8,
- Antonio Colombo9 and
- Azeem Latib1
- 1Interventional Cardiology Institute San Raffaele Hospital, Milan, Milan, Italy
- 2Imperial College London, London, United Kingdom
- 3Spedali civili brescia, Brescia, Brescia, Italy
- 4ASST Niguarda General Hospital - De Gasperis Cardio Center, Milan, Milan, Italy
- 5Ospedale di Cisanello, Pisa, Pisa, Italy
- 6Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
- 7Ferrarotto Hospital, Cardiology Division, University of Catania, Catania, Italy
- 8Humanitas Research Hospital, Rozzano, Milan, Italy
- 9Interventional Cardiology Institute San Raffaele Hospital - Stamford Hospital - Columbia University - Centro Cuore Columbus, Milan, Milan, Italy
Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for severe aortic stenosis (AS). AS and coronary artery disease frequently coincide, and therefore some patients may require coronary angiography (CAG) and/or intervention (PCI) post-TAVR. Due to valve stent design, self-expanding prostheses usually cover the coronary ostium, and therefore may hinder future access. The objective of this research was to evaluate the safety and feasibility of CAG/PCI in patients with prior self-expanding TAVR valves.
Among 2170 patients (age 82±6 years, 43% male) who underwent TAVR with Corevalve or Evolut prostheses as part of the Italian CoreValve Clinical Service framework (data from 13 Italian centers), the occurrence of CAG/PCI following TAVR and periprocedural characteristics were examined.
Forty-six CAG and/or PCI procedures (18 CAG, 13 PCI, 15 both PCI/CAG) were performed in 41 patients (3.2 %); 19 before discharge following TAVR and 27 after discharge. Majority of the procedures were in emergency/ urgent settings (66.7% of CAG and 53.6% of PCI). Left system coronary angiography was successfully performed in most cases (28/33, 84.8%), mainly with a Judkins-left catheter, while right coronary angiography was successful only in 48.5% (16/33). PCI procedures (19 for left system, 2 for right system, 4 for graft, and 3 for unknown) were successfully performed in all cases (100%), and the mean number of guiding catheters used was 1.9±1.8. No CAG/PCI procedure-related complications including prosthesis dislodgment or coronary ostium dissection occurred.
CAG / PCI procedure following CoreValve TAVR is safe and mostly feasible, although the success rate of selective right coronary angiography was relatively low when compared to the left system. Further investigations are required to explore this issue.
STRUCTURAL: Valvular Disease: Aortic