Coronary Procedures After TAVI With the Self‐Expanding Aortic Bioprosthesis Medtronic CoreValve™, Not an Easy Matter

Abstract

Coronary procedures after CoreValve™ TAVI are feasible, but challenging. This problem is currently rare but will be more common as the indications of TAVI are expanded to younger patients with longer life expectancies. Recommendations for post-TAVI coronary procedures are needed, particularly for centers unfamiliar with the management of post-TAVI patients.

Feasibility of coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement using a Medtronic™ self‐expandable bioprosthetic valve

“…There are few published data regarding the feasibility of CA after TAVR prosthesis implantation . According to Boukantar et al, CA was performed successfully only in 9 of 16 patients post‐TAVR . Although we were able to selectively engage 95% of the coronary arteries, additional catheters and manipulations were necessary, and the fluoroscopy time of 11.5 min greatly exceeded the national average of 5 min for diagnostic catheterization .…”

“…There are few published data regarding the feasibility of CA after TAVR prosthesis implantation . According to Boukantar et al, CA was performed successfully only in 9 of 16 patients post‐TAVR .…”

Clinical and Technical Characteristics of Coronary Angiography and Percutaneous Coronary Interventions Performed before and after Transcatheter Aortic Valve Replacement with a Balloon-Expandable Valve

“…Aortic stenosis and coronary artery disease often coexist [1, 5–7], and updated international guidelines on coronary revascularization currently deem implementation of percutaneous coronary interventions on patients with symptomatic CAD prior to TAVR as appropriate [8, 9]. This practice has in fact long been adopted not only in our institution but also in most centers worldwide [7, 10–14]. The rationale for providing complete revascularization for impending TAVR candidates is based on the notion of lowering the risk from coronary ischemia that may transiently occur during the TAVR procedure per se (i.e., during rapid ventricular pacing and aortic balloon inflation) [7, 10, 12] along with improving symptoms and clinical outcomes post-TAVR.…”

Incidence and feasibility of coronary access after transcatheter aortic valve replacement

“…In fact, unlike for surgical aortic valve replacement, where the prosthesis is sutured under direct vision to match the prosthesis to the native aortic valve commissures, during TAVR valve orientation is random and therefore a commissural post can end up directly in front of the coronary ostium, making CA difficult 19,20 . Few experiences on the feasibility of coronary angiography and/or PCI after TAVR have revealed mixed results, with challenges reported primarily with the self‐expanding supra‐annular THVs 8,21,22 . In our study, CA of both coronary vessels was possible in all cases with an intra‐annular THV.…”

“…Few data exist on the incidence of coronary access (CA) after TAVR outside the peri‐procedural period. In fact, previous reports focused on peri‐procedural management of acute coronary obstruction during TAVR deployment 6 or on technical feasibility of PCI with a single TAVR device 7–10 . Due to the extension of TAVR indications towards patients who are younger and at lower risk 11–13 with the possibility of CAD progression, the ability to reaccess the coronary ostia for angiography and potentially to perform PCI after TAVR will become of paramount importance.…”