Provides a practical guide for managing the technical challenges of performing coronary angiography and PCI in patients who have previously undergone TAVR.
Transcatheter aortic valve replacement (TAVR) has revolutionized the management of patients with symptomatic severe aortic stenosis, and indications are expanding towards treating younger patients with lower-risk profiles. Given the progressive nature of coronary artery disease and its high prevalence in those with severe aortic stenosis, coronary angiography and percutaneous coronary intervention will become increasingly necessary in patients after TAVR. There are some data suggesting that there are technical difficulties with coronary re-engagement, particularly in patients with self-expanding valves that, by design, extend above the coronary ostia. The authors review the challenges of coronary angiography and percutaneous coronary intervention post-TAVR and examine the geometric interactions between currently approved transcatheter aortic valves and coronary ostia, while providing a practical guide on how to manage these potentially complex situations.
“Once you have this kind of algorithm, it's easier and faster than . . . trying 10 catheters to finally engage. You know, number one is this, and if number one does not work you go to number two.”
Yudi et al. (2018) studied this question.