Unplanned Percutaneous Coronary Revascularization After TAVR

Stefanini, Giulio G.; Cerrato, Enrico; Pivato, Carlo Andrea; Joner, Michael; Testa, Luca; Rheude, Tobias; Pilgrim, Thomas; Pavani, Marco; Brouwer, Jorn; Otero, Diego López; García, Eulogio; Barbanti, Marco; Biasco, Luigi; Varbella, Ferdinando; Reimers, Bernhard; Díaz, Víctor Alfonso Jiménez; Leoncini, Massimo; Tahoces, Maria Luisa Salido; Ielasi, Alfonso; Hernández, José M. de la Torre; Mylotte, Darren; Garot, Philippe; Chieffo, Alaide; Nombela‐Franco, Luis; Investigators, Revival

doi:10.1016/j.jcin.2020.10.031

Cited by 36 publications

(21 citation statements)

References 41 publications

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“…In patients who have undergone SAVR, it is easier to perform coronary angiography because native leaflets are removed and surgical prosthesis is aligned to native commissures. At two years of follow-up, Ochiai et al [64] demonstrated that there is no difference in terms of outcomes as long as timing of PCI in TAVI candidates is tailored on a single patient by the Heart Team. It should be noted that, in all patients who had to implant self-expanding valve, the Heart Team always chose to perform PCI before TAVI [64] .…”

Section: The Optimal Timing Of Revascularizationmentioning

confidence: 99%

“…At two years of follow-up, Ochiai et al [64] demonstrated that there is no difference in terms of outcomes as long as timing of PCI in TAVI candidates is tailored on a single patient by the Heart Team. It should be noted that, in all patients who had to implant self-expanding valve, the Heart Team always chose to perform PCI before TAVI [64] . According to the current studies, the best approach is to customize revascularization timing considering clinical characteristics, type of transcatheter aortic valve chosen, and complexity of CAD.…”

Section: The Optimal Timing Of Revascularizationmentioning

confidence: 99%

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Management of concomitant coronary artery disease and aortic valve stenosis in the era of transcatheter aortic valve treatment

Aurigemma¹,

Romagnoli²,

Bianchini³

et al. 2022

MIS

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Severe calcific aortic stenosis (AS) and coronary artery disease (CAD) have common risk factors and are frequently encountered in the same patient in clinical practice. CAD has been reported in ≥ 50% of AS patients undergoing both surgical treatment and transcatheter aortic valve implantation (TAVI). In the last two decades, TAVI has been established as a less invasive alternative to surgery. Recently, more and more young and low surgical risk patients undergo TAVI. Despite the high prevalence of CAD in patients treated with TAVI, the management strategy of concomitant CAD in these patients remains an area of considerable uncertainty. This review provides an updated overview of the current knowledge about this topic and offers points for reflection about the best approach to use.

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Section: The Optimal Timing Of Revascularizationmentioning

confidence: 99%

Section: The Optimal Timing Of Revascularizationmentioning

confidence: 99%

Management of concomitant coronary artery disease and aortic valve stenosis in the era of transcatheter aortic valve treatment

Aurigemma¹,

Romagnoli²,

Bianchini³

et al. 2022

MIS

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“…Stefanini et al’s study, based on multicentre international registry data, reported PCI due to ACS after TAVI at a median time of 191 days. [ 61 ] There was PCI success in 96.6%, and no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% versus 94.9%; p=0.150). [ 61 ] However, considering a retrospective cohort study, statistical analysis limitations and significant biases may affect the conclusion.…”

Section: Coronary Complications Post-tavimentioning

confidence: 99%

“…[ 61 ] There was PCI success in 96.6%, and no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% versus 94.9%; p=0.150). [ 61 ] However, considering a retrospective cohort study, statistical analysis limitations and significant biases may affect the conclusion. Another recent cohort of 779 patients reported an incidence of ~10% of an ACS at a median follow-up of ~2 years.…”

Section: Coronary Complications Post-tavimentioning

confidence: 99%

Coronary Artery Disease in Patients with Aortic Stenosis and Transcatheter Aortic Valve Implantation: Implications for Management

Filho¹,

Accorsi

Ribeiro

2021

Eur Cardiol

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Aortic valve stenosis (AS) is the most common valvular heart disease among elderly patients. Since the pathophysiology of degenerative AS shares common pathways with atherosclerotic disease, the severity of AS in the elderly population is often concurrent to the presence of coronary artery disease (CAD). Although surgical aortic valve replacement has been the standard treatment for severe AS, the high operative morbidity and mortality in complex and fragile patients was the trigger to develop less invasive techniques. Transcatheter aortic valve implantation (TAVI) has been posed as the standard of care for elderly patients with severe AS with various risk profiles, which has meant that the concomitant management of CAD has become a crucial issue in such patients. Given the lack of randomised controlled trials evaluating the management of CAD in TAVI patients, most of the recommendations are based on retrospective cohort studies so that the Heart Team approach – together with an assessment of multiple parameters including symptoms and clinical characteristics, invasive and non-invasive ischaemic burden and anatomy – are crucial for the proper management of these patients. This article provides a review of current knowledge about assessment and therapeutic approaches for CAD and severe AS in patients undergoing TAVI.

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“…The number of ViV-TAVI procedures is further expected to increase given the expansion of TAVI toward low surgical-risk patients, in whom ViV-TAVI represents a potential treatment strategy for the lifelong management of severe aortic stenosis ( 5 – 8 ). As a consequence, an increased cumulative risk for repeat invasive angiography or percutaneous coronary intervention (PCI) procedures is expected in the next years ( 9 – 11 ). Therefore, the evaluation of coronary access following ViV-TAVI is increasingly relevant when considering the optimal sequential valve treatment for younger patients ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Coronary access following ACURATE neo implantation for transcatheter aortic valve-in-valve implantation: Ex vivo analysis in patient-specific anatomies

Khokhar

Ponticelli

Złahoda-Huzior

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCoronary access after transcatheter aortic valve implantation (TAVI) with supra-annular self-expandable valves may be challenging or un-feasible. There is little data concerning coronary access following transcatheter aortic valve-in-valve implantation (ViV-TAVI) for degenerated surgical bioprosthesis.AimsTo evaluate the feasibility and challenge of coronary access after ViV-TAVI with the supra-annular self-expandable ACURATE neo valve.Materials and methodsSixteen patients underwent ViV-TAVI with the ACURATE neo valve. Post-procedural computed tomography (CT) was used to create 3D-printed life-sized patient-specific models for bench-testing of coronary cannulation. Primary endpoint was feasibility of diagnostic angiography and PCI. Secondary endpoints included incidence of challenging cannulation for both diagnostic catheters (DC) and guiding catheters (GC). The association between challenging cannulations with aortic and transcatheter/surgical valve geometry was evaluated using pre and post-procedural CT scans.ResultsDiagnostic angiography and PCI were feasible for 97 and 95% of models respectively. All non-feasible procedures occurred in ostia that underwent prophylactic “chimney” stenting. DC cannulation was challenging in 17% of models and was associated with a narrower SoV width (30 vs. 35 mm, p < 0.01), STJ width (28 vs. 32 mm, p < 0.05) and shorter STJ height (15 vs. 17 mm, p < 0.05). GC cannulation was challenging in 23% of models and was associated with narrower STJ width (28 vs. 32 mm, p < 0.05), smaller transcatheter-to-coronary distance (5 vs. 9.2 mm, p < 0.05) and a worse coronary-commissural overlap angle (14.3° vs. 25.6o, p < 0.01). Advanced techniques to achieve GC cannulation were required in 22/64 (34%) of cases.ConclusionIn this exploratory bench analysis, diagnostic angiography and PCI was feasible in almost all cases following ViV-TAVI with the ACURATE neo valve. Prophylactic coronary stenting, higher implantation, narrower aortic sinus dimensions and commissural misalignment were associated with an increased challenge of coronary cannulation.

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Unplanned Percutaneous Coronary Revascularization After TAVR

Cited by 36 publications

References 41 publications

Management of concomitant coronary artery disease and aortic valve stenosis in the era of transcatheter aortic valve treatment

Management of concomitant coronary artery disease and aortic valve stenosis in the era of transcatheter aortic valve treatment

Coronary Artery Disease in Patients with Aortic Stenosis and Transcatheter Aortic Valve Implantation: Implications for Management

Coronary access following ACURATE neo implantation for transcatheter aortic valve-in-valve implantation: Ex vivo analysis in patient-specific anatomies

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