Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

Figure 1. The management of CAD in TAVI patients: who need myocardial revascularization and when? Abbreviations: ACS, Acute coronary syndrome; PCI, Percutaneous coronary intervention; CAD, Coronary artery disease.

Figure 2. Functional assessment after TAVI implantation. Explanatory case showing the feasibility of performing functional assessment after valve implantation (Sapien 3, 26 mm, Edwards Lifesciences, Irvine, CA, USA) in a patient with moderate atheroma on the right coronary artery. This approach has the advantage of avoiding misleading interpretation of physiological indices in presence of Scheme 0. IMR was 14 U suggesting non inducible ischemia and preserved microvascular resistance. Below: RFR, a non-hyperemic full cycle pressure-wire based index, was 0.94 and three-dimensional (3D) quantitative coronary analysis and subsequent QFR computation was 0.89. Abbreviations: FFR, fractional flow reserve; QFR, quantitative flow ratio; IMR, index of micro-vascular resistance; RFR, resting full cycle ratio.

Figure 3. PCI with rotational atherectomy and stenting after TAVI (Edwards Sapien 3). (A) Coronary angiography after selective cannulation of left coronary artery showed severe calcific lesion of the mid left anterior descending. (B) Rotational atherectomy. (C) Predilation of the lesion with non-compliant balloon. (D) Final result after stent implantation.

Figure 4. Feasibility of coronary access post TAVI. Coronary angiography performed after TAVI thorough the CoreValve Evolut R struts. (A) Right coronary artery selective cannulation using a Judkins right catheter (JR 4, Cordis Corporation, Bridgewater, NJ, USA); (B) Left coronary artery selective cannulation with an extra backup support catheter (EBU 3.5, Medtronic Inc., Minneapolis, MN, USA).