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Complexity assessment and technical aspect of coronary angiogram and percutaneous coronary intervention following transcatheter aortic valve implantation
Affiliations- Cardiology Division of the University Hospital of Geneva, Switzerland
open access
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 our 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 our 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.
Keywords
transcatheter aortic valve implantation, coronary angiogram, percutaneous coronary intervention, self-expandable transcatheter heart valve
About this articleTitle
Complexity assessment and technical aspect of coronary angiogram and percutaneous coronary intervention following transcatheter aortic valve implantation
Journal
Issue
Article type
Original Article
Pages
197-204
Published online
2020-05-20
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5653
Article views/downloads
1267
DOI
Pubmed
Bibliographic record
Cardiol J 2022;29(2):197-204.
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
References (27)- Nkomo V, Gardin J, Skelton T, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006; 368(9540): 1005–1011.
- Odden MC, Coxson PG, Moran A, et al. The impact of the aging population on coronary heart disease in the United States. Am J Med. 2011; 124(9): 827–33.e5.
- Snow TM, Ludman P, Banya W, et al. Management of concomitant coronary artery disease in patients undergoing transcatheter aortic valve implantation: the United Kingdom TAVI Registry. Int J Cardiol. 2015; 199: 253–260.
- Ramee S, Anwaruddin S, Kumar G, et al. The rationale for performance of coronary angiography and stenting before transcatheter aortic valve replacement: from the interventional section leadership council of the american college of cardiology. JACC Cardiovasc Interv. 2016; 9(23): 2371–2375.
- Kotronias RA, Teitelbaum M, Webb JG, et al. Transcatheter aortic valve implantation with or without percutaneous coronary artery revascularization strategy: a systematic review and meta-analysis. J Am Heart Assoc. 2017; 6(6): 1759–1771.
- Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019; 40(2): 87–165.
- Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Nucl Cardiol. 2017; 24(5): 1759–1792.
- Khawaja MZ, Wang D, Pocock S, et al. The percutaneous coronary intervention prior to transcatheter aortic valve implantation (ACTIVATION) trial: study protocol for a randomized controlled trial. Trials. 2014; 15: 300.
- Perrin N, Roffi M, Frei A, et al. Thirty-day outcome following corevalve evolut r transcatheter aortic valve implantation: an all-comers prospective study. Rev Esp Cardiol (Engl Ed). 2017; 70(9): 713–719.
- Htun WW, Grines C, Schreiber T. Feasibility of coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement using a Medtronic™ self-expandable bioprosthetic valve. Catheter Cardiovasc Interv. 2018; 91(7): 1339–1344.
- Zivelonghi C, Pesarini G, Scarsini R, et al. Coronary catheterization and percutaneous interventions after transcatheter aortic valve implantation. Am J Cardiol. 2017; 120(4): 625–631.
- Chakravarty T, Sharma R, Abramowitz Y, et al. Outcomes in patients with transcatheter aortic valve replacement and left main stenting: the TAVR-LM registry. J Am Coll Cardiol. 2016; 67(8): 951–960.
- Yudi MB, Sharma SK, Tang GHL, et al. Coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement. J Am Coll Cardiol. 2018; 71(12): 1360–1378.
- Blumenstein J, Kim WK, Liebetrau C, et al. Challenges of coronary angiography and intervention in patients previously treated by TAVI. Clin Res Cardiol. 2015; 104(8): 632–639.
- Allali A, El-Mawardy M, Schwarz B, et al. Incidence, feasibility and outcome of percutaneous coronary intervention after transcatheter aortic valve implantation with a self-expanding prosthesis. Results from a single center experience. Cardiovasc Revasc Med. 2016; 17(6): 391–398.
- Boukantar M, Gallet R, Mouillet G, et al. Coronary procedures after TAVI with the self-expanding aortic bioprosthesis medtronic corevalve™, not an easy matter. J Interv Cardiol. 2017; 30(1): 56–62.
- Ferreira-Neto AN, Puri R, Asmarats L, et al. Clinical and technical characteristics of coronary angiography and percutaneous coronary interventions performed before and after transcatheter aortic valve replacement with a balloon-expandable valve. J Interv Cardiol. 2019; 2019: 3579671.
- Tanaka A, Jabbour RJ, Testa L, et al. Incidence, technical safety, and feasibility of coronary angiography and intervention following self-expanding transcatheter aortic valve replacement. Cardiovasc Revasc Med. 2019; 20(5): 371–375.
- Ochiai T, Chakravarty T, Yoon SH, et al. Coronary access after TAVR. JACC Cardiovasc Interv. 2020; 13(6): 693–705.
- Couture T, Faroux L, Junquera L, et al. Interaction between self-expanding transcatheter heart valves and coronary ostia: an angiographically based analysis of the evolut r/pro valve system. J Invasive Cardiol. 2020; 32(4): 123–128.
- Harhash A, Ansari J, Mandel L, et al. STEMI After TAVR: Procedural Challenge and Catastrophic Outcome. JACC Cardiovasc Interv. 2016; 9(13): 1412–1413.
- Tang GHL, Zaid S, Ahmad H, et al. Transcatheter valve neo-commissural overlap with coronary orifices after transcatheter aortic valve replacement. Circ Cardiovasc Interv. 2018; 11(10): e007263.
- Fuchs A, Kofoed KF, Yoon SH, et al. Commissural alignment of bioprosthetic aortic valve and native aortic valve following surgical and transcatheter aortic valve replacement and its impact on valvular function and coronary filling. JACC Cardiovasc Interv. 2018; 11(17): 1733–1743.
- Tang GHL, Zaid S, Gupta E, et al. Impact of initial evolut transcatheter aortic valve replacement deployment orientation on final valve orientation and coronary reaccess. Circ Cardiovasc Interv. 2019; 12(7): e008044.
- Mack M, Leon M, Smith C, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. The Lancet. 2015; 385(9986): 2477–2484.
- Barbanti M, Webb JG, Tamburino C, et al. Outcomes of redo transcatheter aortic valve replacement for the treatment of postprocedural and late occurrence of paravalvular regurgitation and transcatheter valve failure. Circ Cardiovasc Interv. 2016; 9(9): e003930.
- Søndergaard L. Transcatheter aortic valve implantation: don’t forget the coronary arteries! EuroIntervention. 2018; 14(2): 147–149.
