Percutaneous Coronary Interventions in Patients With Prior Transcatheter Aortic Valve Replacement

Q: What are the key findings of this study?

Percutaneous coronary intervention following transcatheter aortic valve replacement achieved a 96% technical success rate, with no significant difference between balloon-expandable and self-expanding valves.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary artery disease post-Transcatheter Aortic Valve Replacement (TAVR) (n=44). Intervention: Percutaneous coronary intervention. Primary outcome: Technical success rate of percutaneous coronary intervention.

Q: What does this research mean for the field?

Percutaneous coronary intervention after transcatheter aortic valve replacement achieves high procedural and technical success rates, with comparable success between balloon-expandable and self-expanding valves. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chloe Kharsa; Gal Sella; Hassaan Arshad; Joe Aoun; Taha Hatab; Sahar Samimi; Fatima Qamar; Rody Bou Chaaya; Alpesh Shah; Syed Zaid; Neal S. Kleiman; Sachin S. Goel

doi:10.1016/j.jacadv.2025.102567

January 20, 2026JACC AdvancesOpen Access

Percutaneous Coronary Interventions in Patients With Prior Transcatheter Aortic Valve Replacement

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Key result

PCI after TAVR achieves ~96% technical success regardless of valve type.

n=44

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Why the study?

Coronary access post-TAVR can be challenging, prompting an evaluation of the feasibility, technical aspects, and success rate of PCI in these patients.

Key Points

To assess the feasibility, technical characteristics, and success rate of percutaneous coronary intervention in patients with prior transcatheter aortic valve replacement.
Retrospectively analyzed 51 PCI procedures performed in 44 patients out of a single-center cohort of 2,298 TAVR recipients.
Evaluated procedural and technical aspects of PCI across balloon-expandable (39.2%) and self-expanding (60.8%) transcatheter heart valves.
Technical success of PCI was achieved in 96% of procedures (49/51), with no difference between balloon-expandable and self-expanding valves (100% vs 93.5%, 95% CI -2.2 to 15.2; P = 0.25).
Urgent PCI occurred in 64.7% of cases, with selective coronary engagement achieved in 86.3% and overall coronary engagement successful in 98% (50/51 procedures).
In-hospital mortality was 2.0% (1/51), with no coronary artery perforations or dissections, while all-cause mortality reached 41.4% at a mean follow-up of 25.6 months.

Study Design

Type

Cohort (n=44)

Multicenter

No

Structured PICO

P

Population

44 patients with prior transcatheter aortic valve replacement who required percutaneous coronary intervention, followed for a mean of 25.6 months.

I

Intervention

Percutaneous coronary intervention (PCI) performed post-TAVR for indications including stable angina or acute coronary syndrome.

O

Outcome

Technical success rate of PCI, defined as successful deployment of the intended device at the target lesion with residual stenosis <30% and TIMI flow grade 3.

PCI in patients with a history of TAVR is highly feasible and successful (96% technical success) when appropriate techniques such as selective cannulation or airmailing guidewires are utilized.

Limitations

Retrospective design at a single center introduces inherent biases, including time bias.
Relatively small sample size limits the generalizability of the findings.
Absence of a control group.
Systematic evaluation of commissural or coronary misalignment was not feasible due to lack of routine post-TAVR computed tomography.
Technical success rate may be influenced by the single high-volume institution's operator expertise.
Lack of complete lesion-level data for patients who underwent PCI at outside hospitals.
Relatively small sample size limits generalizability.
No systematic evaluation of commissural or coronary misalignment due to lack of post-TAVR computed tomography.
Incomplete lesion-level data for procedures performed at outside hospitals.

Implication

Supports post-TAVR PCI feasibility when indicated; leaves open need for prospective outcome data.

Abstract

BACKGROUND: Coronary access post-transcatheter aortic valve replacement (TAVR) can be challenging. We evaluated technical aspects of percutaneous coronary intervention (PCI) in patients post-TAVR. OBJECTIVES: The aim of the study was to assess the feasibility, technical aspects, and success rate of PCI in patients who have previously undergone TAVR. METHODS: We retrospectively evaluated data on patients undergoing PCI after TAVR focusing on the procedural and technical aspects of PCI. The primary endpoint was the technical success rate of PCI. RESULTS: Out of 2,298 patients undergoing TAVR, 44 (1.9%) underwent PCI (total 51 PCI cases) post-TAVR (39.2% after balloon-expandable, 60.8% after self-expanding transcatheter heart valve). Mean age was 76 ± 9.01 years; 39.2% were women. The median time-to-PCI post-TAVR was 25.92 ± 33.35 months. In almost a third of patients, indication for PCI was stable angina (35.3%), two-thirds had PCI for acute coronary syndrome (7.8% ST-segment elevation myocardial infarction, 39.2% non-ST-segment elevation myocardial infarction, and 17.6% unstable angina). Urgent PCI was performed in 64.7%. Predominant access route was femoral (88.2%). Selective guide catheter coronary engagement was possible in 86.3%, and guide catheter extension in 13.7%. Guidewire airmailing and use of guide extension catheter were required in 11.8%. Atherectomy was performed in 11.7%. PCI technical success was achieved in 96% (49/51 procedures). There was no difference in technical success in patients with balloon-expandable vs self-expanding TAVR (100% vs 93.5%; P = 0.25). CONCLUSIONS: Despite anatomical challenges posed by transcatheter heart valves, coronary access and PCI post-TAVR are highly successful when appropriate techniques are employed. As TAVR continues to expand to younger patients with longer life expectancy, operator familiarity with coronary access strategies will be essential to optimize post-TAVR care.

Discussion

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Cite This Study

Kharsa et al. (2026) conducted a cohort in Coronary artery disease post-Transcatheter Aortic Valve Replacement (TAVR) (n=44). Percutaneous coronary intervention was evaluated on Technical success rate of percutaneous coronary intervention. Percutaneous coronary intervention following transcatheter aortic valve replacement achieved a 96% technical success rate, with no significant difference between balloon-expandable and self-expanding valves.

synapsesocial.com/papers/6a0ff08928c2d29469fe38a4 https://doi.org/10.1016/j.jacadv.2025.102567

Topics

Percutaneous coronary intervention

Chronic total occlusion PCI

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Percutaneous Coronary Interventions in Patients With Prior Transcatheter Aortic Valve Replacement

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Percutaneous Coronary Interventions in Patients With Prior Transcatheter Aortic Valve Replacement

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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