Low rate of invasive coronary angiography following transcatheter aortic valve implantation: real-world prospective cohort findings

Mariana Gonçalves, Pedro de Araújo Gonçalves, Rui Campante Teles*, Manuel de Sousa Almeida, Afonso Félix de Oliveira, João Brito, Luís Raposo, Henrique Mesquita Gabriel, Tiago Nolasco, José Pedro Neves, Miguel Mendes, Hector M. Garcia-Garcia*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Aim: To evaluate the real need for coronary access after transcatheter aortic valve implantation (TAVI). Methods and results: Prospective observational single-center registry, including 563 consecutive patients who underwent TAVI between April 2008 and November 2018, with both self- and balloon-expandable valves in a tertiary European center. Mean age was 82.4 ± 6.9 years, 53.3% were female, 16% had previous history of coronary artery bypass grafting, 33% of previous percutaneous coronary intervention (PCI), and 16.6% of myocardial infarction (MI). Twenty-four percent of the patients were revascularized within one year before TAVI in preparation for the procedure. Median Society of Thoracic Surgeons score was 4.82 (IQ 2.84). In a median follow-up of 24 months (IQ 21.5), 18 patients (3.2%) were identified as potentially in need for invasive coronary angiography: 9 (1.6%) in the setting of stable coronary artery disease and 9 (1.6%) for an acute coronary syndrome. A total of 11 PCIs were performed in 9 patients, with a complete success rate of 63.6%. Procedures that were unsuccessful or partially unsuccessful were due to the inability to cross the stent or the drug-eluting balloon through the valve struts or misplacement within the coronary artery due to lack of catheter support. Conclusion: In this population, a strategy of previous guideline-directed revascularization before TAVI was associated with a low rate of MI and repeated need of coronary access, with a scattered distribution over time. Assuring future access to coronary arteries in patients at increased risk may depend on the revascularization strategy rather than device selection.

Original languageEnglish
Pages (from-to)42-49
Number of pages8
JournalCardiovascular Revascularization Medicine
Volume28
DOIs
Publication statusPublished - Jul 2021
Externally publishedYes

Keywords

  • Aortic stenosis
  • Catheter engagement
  • Coronary artery disease
  • Invasive coronary angiography
  • Transcatheter aortic valve implantation

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