Coronary Angiography After Transcatheter Aortic Valve Replacement (TAVR) to Evaluate the Risk of Coronary Access Impairment After TAVR‐in‐TAVR
Key result
Implantation of a supra-annular transcatheter heart valve was an independent predictor of impaired coronary access after TAVR-in-TAVR (OR 6.61; 95% CI 1.98-22.03; P=0.002).
Why the study?
Displaced leaflets of a first THV create a risk plane during TAVR-in-TAVR below which coronary catheter passage is impossible, creating an unknown risk of impaired coronary access.
What is the risk of impaired coronary access after TAVR-in-TAVR, and what are the predictors of impairment?
Population
137 consecutive patients undergoing TAVR with different THVs
Comparison
Sapien 3 vs Evolut Pro/R vs Acurate Neo THV
Design
Prospective observational study
Authors
Discussion
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Implication
May affect valve selection to preserve future coronary access; leaves open prospective validation of predictors.
Key Points
- To evaluate the risk of impaired coronary access following transcatheter aortic valve-in-valve implantation across different transcatheter heart valve designs.
- Prospectively evaluated N=137 consecutive patients undergoing coronary angiography after TAVR with Sapien 3 (n=72), Evolut Pro/R (n=26), or Acurate Neo (n=39) transcatheter heart valves.
- Assessed coronary access feasibility based on whether the catheter crossed above the risk plane or below it with a valve-to-aorta distance >2 mm (theoretically feasible) versus ≤2 mm (unfeasible) using aortic angiography.
- Coronary access after TAVR-in-TAVR was feasible in 40.9% of patients (68.1% for Sapien 3, 19.2% for Evolut, and 5.1% for Acurate Neo; P < 0.001) and unfeasible in 31.4% (23.6% for Sapien 3, 38.5% for Evolut, and 41.1% for Acurate Neo; P = 0.116).
- Independent predictors of impaired coronary access were female sex (OR, 3.99; 95% CI, 1.07–14.86; P = 0.040), smaller sinotubular junction diameter (OR, 0.62; 95% CI, 0.48–0.80; P < 0.001), and supra-annular valve design (OR, 6.61; 95% CI, 1.98–22.03; P = 0.002).
Study Design
Type
Observational (n=137)
Structured PICO
What is the risk of impaired coronary access after TAVR-in-TAVR, and what are the predictors of impairment?
P
Population
137 consecutive patients undergoing transcatheter aortic valve replacement evaluated prospectively for the risk of impaired coronary access after TAVR-in-TAVR.
E
Exposure
Coronary angiography performed after initial TAVR to evaluate the risk of impaired coronary access after theoretical TAVR-in-TAVR
O
Outcome
Feasibility of coronary access after TAVR-in-TAVR (categorized as feasible, theoretically feasible, or unfeasible based on catheter passage relative to the risk plane and valve-to-aorta distance)surrogate
Main Result
Odds Ratio: 6.61 (95% CI 1.98–22.03)
p-value: p=0.002
Coronary access after TAVR-in-TAVR may be unfeasible in over 30% of patients, with higher risk observed in women, patients with small sinotubular junctions, and those receiving supra-annular valves.
Cite This Study
Fovino et al. (2020) conducted an observational in Transcatheter aortic valve replacement (TAVR) (n=137). Supra-annular transcatheter heart valve (THV) vs. Non-supra-annular THV was evaluated on Impaired coronary access after TAVR-in-TAVR (OR 6.61, 95% CI 1.98-22.03, p=0.002). Implantation of a supra-annular transcatheter heart valve was an independent predictor of impaired coronary access after TAVR-in-TAVR (OR 6.61; 95% CI 1.98-22.03; P=0.002).