Impact of Valve Frame Height on PCI Outcomes After TAVR

BACKGROUND: Coronary access after transcatheter aortic valve replacement (TAVR) remains challenging, particularly with tall-framed valves (TFVs), raising concerns about long-term percutaneous coronary intervention (PCI). OBJECTIVES: The aim of this study was to evaluate the impact of bioprosthetic aortic valve type on long-term clinical outcomes in patients undergoing PCI following TAVR. METHODS: Data were derived from the multicenter REVIVAL-PCI registry, which included patients from 21 European centers who underwent PCI after TAVR between 2008 and 2023. Patients were classified according to valve frame height: TFVs or short-framed valves (SFVs). The primary endpoint was the 4-year incidence of major adverse cardiovascular events, defined as the composite of cardiovascular death, myocardial infarction, or stroke. Cumulative event rates were estimated using Kaplan-Meier method, and weighted Cox regression models using an entropy balance approach were used to adjust for imbalances in clinical and procedural confounders. RESULTS: The analysis included 441 patients, with 230 having undergone TAVR with SFVs (30.9% women) and 211 with TFVs (44.1% women). The median follow-up after PCI was 908 days (Q1-Q3: 322-1,728 days). The 4-year incidence of major adverse cardiovascular events was comparable between the SFV and TFV groups (38.1% [95% CI: 24.6%-43.9%] vs 31.9% [95% CI: 24.8%-41.0%]; HR: 1.04; 95% CI: 0.71-1.52; P = 0.846). Similar findings were observed after adjustment for potential confounders. CONCLUSIONS: In current practice, long-term outcomes after PCI in TAVR patients do not appear to be significantly different between those receiving SFVs and TFVs. Future investigations with newer generation valves and refined implantation techniques are needed to clarify these associations and optimize management strategies.