Coronary Access After TAVR

Autor: Sung-Han Yoon, Tomoki Ochiai, Wen Cheng, Nir Flint, Tarun Chakravarty, Ripandeep Tiwana, Vivek Patel, Mamoo Nakamura, Sahar Mahani, Raj Makkar, Danon Kaewkes, Navjot Sekhon
Rok vydání: 2020
Předmět:
Male
Aortic valve
Cardiac Catheterization
medicine.medical_specialty
Computed Tomography Angiography
medicine.medical_treatment
030204 cardiovascular system & hematology
Coronary Angiography
Prosthesis Design
Severity of Illness Index
Transcatheter Aortic Valve Replacement
Coronary artery disease
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Left coronary artery
Valve replacement
Predictive Value of Tests
Risk Factors
Internal medicine
medicine.artery
Humans
Medicine
Registries
030212 general & internal medicine
Heart valve
Aged
Retrospective Studies
Aged
80 and over

business.industry
Coronary Stenosis
Percutaneous coronary intervention
Aortic Valve Stenosis
medicine.disease
Coronary Vessels
Treatment Outcome
medicine.anatomical_structure
Aortic Valve
Heart Valve Prosthesis
Aortic valve stenosis
Right coronary artery
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Zdroj: JACC: Cardiovascular Interventions. 13:693-705
ISSN: 1936-8798
0231-8342
DOI: 10.1016/j.jcin.2020.01.216
Popis: Objectives The aim of this study was to assess the incidence of unfavorable coronary access after transcatheter aortic valve replacement (TAVR) using post-implantation computed tomography (CT). Background Real-world data regarding coronary access after TAVR assessed using post-implantation CT are scarce. Methods Post-TAVR CT of 66 patients treated with Evolut R or Evolut PRO valves and 345 patients treated with SAPIEN 3 valves were analyzed. The distance from inflow of the transcatheter heart valve (THV) to the coronary ostia and the overlap between THV commissures and the coronary ostia were assessed. Coronary access was defined as unfavorable if the coronary ostium was below the skirt or in front of the THV commissural posts above the skirt in each coronary artery. Results CT-identified features of unfavorable coronary access were observed in 34.8% (n = 23) for the left coronary artery and 25.8% (n = 17) for the right coronary artery in the Evolut R/Evolut PRO group, while those percentages were 15.7% (n = 54) for the left coronary artery and 8.1% (n = 28) for the right coronary artery in the SAPIEN 3 group. In the Evolut R/Evolut PRO group, 16 coronary engagements were performed after TAVR, while 64 coronary engagements were performed in the SAPIEN 3 group after TAVR. In an engagement-level analysis, the success rates of selective coronary engagement were significantly lower in patients with CT-identified features of unfavorable coronary access compared with those with favorable coronary access in both the Evolut R/Evolut PRO (0.0% vs. 77.8%; p = 0.003) and SAPIEN 3 (33.3% vs. 91.4%; p = 0.003) groups. Conclusions Coronary access may be challenging in a significant proportion of patients after TAVR. THVs with low skirt or commissure height and large open cells that are designed to achieve commissure-to-commissure alignment with the native aortic valve may facilitate future coronary access. (Assessment of Transcatheter and Surgical Aortic Bioprosthetic Valve Thrombosis and Its Treatment With Anticoagulation [RESOLVE]; NCT02318342)
Databáze: OpenAIRE