Overcoming the transcatheter aortic valve replacement Achilles heel: coronary re-access

Arshi, Arash; Yakubov, Steven J.; Stiver, Kevin; Sanchez, Carlos E.

doi:10.21037/acs-2020-av-38

Cited by 8 publications

(6 citation statements)

References 33 publications

(28 reference statements)

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“…If the stent frame of a balloon expandable TAVR protrudes over the coronary ostium or, when the commissures misalign, the coronary is usually engaged through the closest stent strut to allow coaxiality. Coronary angiography or PCI can then proceed normally 6 . However, if stent frame protrusion and commissural misalignment are combined with a pinned leaflet in front of the coronary orifice, engagement through the struts as per usual is precluded.…”

Section: Discussionmentioning

confidence: 99%

“…Coronary angiography or PCI can then proceed normally. 6 However, if stent frame protrusion and commissural misalignment are combined with a pinned leaflet in front of the coronary orifice, engagement through the struts as per usual is precluded. We show that in this setting, engagement of the LMCA cranial from the stent struts is possible, despite the similar height of the TAVR frame and the LMCA.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Bail out lithotripsy to treat delayed valve‐in‐valve TAVR‐related coronary obstruction

Bingen

Amri

Cabezas

et al. 2022

Cathet Cardio Intervent

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Coronary access difficulty and stent compression by the juxtaposed aortic valve leaflet hamper percutaneous management of delayed coronary artery obstruction (CAO) after valve-in-valve (Edwards Sapien 3 in St. Jude Trifecta) transcatheter aortic valve replacement (TAVR). Here, we present a case of delayed post-TAVR CAO treated with intravascular lithotripsy and multistenting to overcome stent compression by the adjacent calcified leaflet.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bail out lithotripsy to treat delayed valve‐in‐valve TAVR‐related coronary obstruction

Bingen

Amri

Cabezas

et al. 2022

Cathet Cardio Intervent

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“…The hat marker is oriented to face the aortic root's outer curve when the delivery system passes through the aortic valve. This ensures proper commissural alignment and prevents overlap with the coronary ostia [36].…”

Section: Corevalve Evolut R and Pro Valves (Medtronic Minneapolis Mn ...mentioning

confidence: 99%

TAVR Interventions and Coronary Access: How to Prevent Coronary Occlusion

Gherasie

Achim

2023

Life

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Due to technological advancements during the past 20 years, transcatheter aortic valve replacements (TAVRs) have significantly improved the treatment of symptomatic and severe aortic stenosis, significantly improving patient outcomes. The continuous evolution of transcatheter valve models, refined imaging planning for enhanced accuracy, and the growing expertise of technicians have collectively contributed to increased safety and procedural success over time. These notable advancements have expanded the scope of TAVR to include patients with lower risk profiles as it has consistently demonstrated more favorable outcomes than surgical aortic valve replacement (SAVR). As the field progresses, coronary angiography is anticipated to become increasingly prevalent among patients who have previously undergone TAVR, particularly in younger cohorts. It is worth noting that aortic stenosis is often associated with coronary artery disease. While the task of re-accessing coronary artery access following TAVR is challenging, it is generally feasible. In the context of valve-in-valve procedures, several crucial factors must be carefully considered to optimize coronary re-access. To obtain successful coronary re-access, it is essential to align the prosthesis with the native coronary ostia. As part of preventive measures, strategies have been developed to safeguard against coronary obstruction during TAVR. One such approach involves placing wires and non-deployed coronary balloons or scaffolds inside an at-risk coronary artery, a procedure known as chimney stenting. Additionally, the bioprosthetic or native aortic scallops intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) procedure offers an effective and safer alternative to prevent coronary artery obstructions. The key objective of our study was to evaluate the techniques and procedures employed to achieve commissural alignment in TAVR, as well as to assess the efficacy and measure the impact on coronary re-access in valve-in-valve procedures.

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“…In cases of difficult RCA engagement post TAVR, shorter tipped catheters such as the FR4 or JR4 may provide greater chance of access success [ 74 ]. Further, the use of a guide catheter rather than diagnostic catheters allows for the utilization of guide wires and guide extension catheters which can help facilitate coronary engagement and allow for equipment delivery [ 75 ]. Similarly, certain techniques can be used to help engage the left main coronary artery after TAVR.…”

Section: Challenges In Coronary Access After Tavrmentioning

confidence: 99%

Coronary Artery Disease and Revascularization in Patients Undergoing Transcatheter Aortic Valve Replacement

Garg¹,

Ilyas²,

Cryer³

et al. 2022

Rev. Cardiovasc. Med.

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Coronary artery disease (CAD) and aortic stenosis share similar risk factors and underlying pathophysiology. Up to half of the patient population undergoing work-up for aortic valve replacement have underlying CAD, which can affect outcomes in patients with more severe disease. As the indications for transcatheter aortic valve replacement (TAVR) have expanded to intermediate and now low risk patients, the optimal management of CAD in this patient population still needs to be determined. This includes both pre-TAVR evaluation for CAD as well as indications for revascularization in patients undergoing TAVR. There is also limited data on coronary interventions after TAVR, including the incidence, feasibility and outcomes of patients undergoing percutaneous coronary intervention (PCI) after TAVR. This review provides an updated report of the current literature on CAD in TAVR patients, focusing on its prevalence, impact on outcomes, timing of revascularization and potential challenges with coronary interventions post-TAVR.

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Overcoming the transcatheter aortic valve replacement Achilles heel: coronary re-access

Cited by 8 publications

References 33 publications

Bail out lithotripsy to treat delayed valve‐in‐valve TAVR‐related coronary obstruction

Bail out lithotripsy to treat delayed valve‐in‐valve TAVR‐related coronary obstruction

TAVR Interventions and Coronary Access: How to Prevent Coronary Occlusion

Coronary Artery Disease and Revascularization in Patients Undergoing Transcatheter Aortic Valve Replacement

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