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Published online: 2020-05-20
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Complexity assessment and technical aspect of coronary angiogram and percutaneous coronary intervention following transcatheter aortic valve implantation

Nils Perrin, Amir Fassa, Antoine Baroz, Caroline Frangos, Stephane Mock, Angela Frei, Murat Cimci, Sophie Degrauwe, Marco Roffi, Juan Fernando Iglesias, Stephane Noble
DOI: 10.5603/CJ.a2020.0073
·
Pubmed: 32436588

open access

Ahead of print
Original articles
Published online: 2020-05-20

Abstract

Background: Performing selective coronary angiogram (CA) and percutaneous coronary intervention (PCI) post transcatheter aortic valve implantation (TAVI) may be challenging with various success rates of coronary ostia engagement.

Methods: Among all patients who underwent CA and/or PCI after TAVI from the documented single center TAVI registry, ostia cannulation success was reported according to the quality of ostia engagement and artery opacification, and was classified as either selective, partially selective or non-selective but sufficient for diagnosis.

Results: Among the 424 consecutive TAVI procedures performed at the aforementioned institution, 20 (4.7%) CA were performed in 19 (4.5%) patients at a median time of 464 days post TAVI (25–75% IQ: 213–634 days). CA were performed in 7 CoreValve, 9 Evolut R, 1 Evolut PRO and 2 Edwards Sapien 3 devices. Transradial vascular approach was attempted in 9 procedures (45%, right n = 6 and left n = 3) and was successful in 8 (40%) patients. A total of 20 left main artery ostium cannulation were attempted leading to a diagnostic CA in all of them with selective engagement in 65%.  Engagement of the right coronary artery in 2 out of 15 attempted cases failed due to a low ostium in conjunction with a high implantation of a CoreValve prosthesis. 11 PCI (55% of CA) including 2 left main lesions were performed. In 4 patients (36.4% of the PCI), an extension catheter was required to engage the left main. All planned PCI were successful.

Conclusions: Post TAVI CA and PCI are challenging but feasible even after supra-annular self-expandable valve implantation.

Abstract

Background: Performing selective coronary angiogram (CA) and percutaneous coronary intervention (PCI) post transcatheter aortic valve implantation (TAVI) may be challenging with various success rates of coronary ostia engagement.

Methods: Among all patients who underwent CA and/or PCI after TAVI from the documented single center TAVI registry, ostia cannulation success was reported according to the quality of ostia engagement and artery opacification, and was classified as either selective, partially selective or non-selective but sufficient for diagnosis.

Results: Among the 424 consecutive TAVI procedures performed at the aforementioned institution, 20 (4.7%) CA were performed in 19 (4.5%) patients at a median time of 464 days post TAVI (25–75% IQ: 213–634 days). CA were performed in 7 CoreValve, 9 Evolut R, 1 Evolut PRO and 2 Edwards Sapien 3 devices. Transradial vascular approach was attempted in 9 procedures (45%, right n = 6 and left n = 3) and was successful in 8 (40%) patients. A total of 20 left main artery ostium cannulation were attempted leading to a diagnostic CA in all of them with selective engagement in 65%.  Engagement of the right coronary artery in 2 out of 15 attempted cases failed due to a low ostium in conjunction with a high implantation of a CoreValve prosthesis. 11 PCI (55% of CA) including 2 left main lesions were performed. In 4 patients (36.4% of the PCI), an extension catheter was required to engage the left main. All planned PCI were successful.

Conclusions: Post TAVI CA and PCI are challenging but feasible even after supra-annular self-expandable valve implantation.

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Keywords

transcatheter aortic valve implantation, coronary angiogram, percutaneous coronary intervention, self-expandable transcatheter heart valve

About this article
Title

Complexity assessment and technical aspect of coronary angiogram and percutaneous coronary intervention following transcatheter aortic valve implantation

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-05-20

DOI

10.5603/CJ.a2020.0073

Pubmed

32436588

Keywords

transcatheter aortic valve implantation
coronary angiogram
percutaneous coronary intervention
self-expandable transcatheter heart valve

Authors

Nils Perrin
Amir Fassa
Antoine Baroz
Caroline Frangos
Stephane Mock
Angela Frei
Murat Cimci
Sophie Degrauwe
Marco Roffi
Juan Fernando Iglesias
Stephane Noble

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