Coronary cannulation after transcatheter aortic valve replacement (TAVR) was unsuccessful in almost 10% of patients. This problem occurred almost exclusively in those who received a self-expanding valve.
This study, recently published in JACC Cardiovasc Interv., was sought to investigate the feasibility of coronary ostia access after TAVR and describe potential predictors of coronary access impairment.
RE-ACCESS (Reobtain Coronary Ostia Cannulation Beyond Transcatheter Aortic Valve Stent) was a prospective, register-based study that enrolled consecutive patients who underwent TAVR using commercially available devices.
All patients underwent coronary angiography before and after TAVR.
Among 300 patients enrolled in the RE-ACCESS study from 2018 to 2020, about 23 (7.7%) could not be selectively catheterized after TAVR.
Read also: ISCHEMIA: New Analysis Might Change Study Outcome Interpretation.
Out of said 23 patients, 22 had received the Evolut R/PRO valve (17.9% vs. 0.4%; p < 0.01).
The multivariate analysis showed that, for the self-expanding prosthesis (odds ratio [OR]: 29.6; 95% confidence interval: 2.6 to 335.0; p < 0.01), the prosthesis height-sinus of Valsalva relation (p < 0.01) and implantation depth (OR: 1.1 per each extra 1 mm in depth; p < 0.01) were independent predictors of unsuccessful selective coronary cannulation.
A model taking into account these factors could predict with very high accuracy the level of access difficulty (area under the curve: 0.94; p < 0.01).
Conclusion
After TAVR, it is impossible to perform selective coronary catheterization in 7.7% of patients. This difficulty appears almost exclusively in patients who received the Evolut prosthesis.
Original Title: Coronary Cannulation After Transcatheter Aortic Valve Replacement. The RE-ACCESS Study.
Reference: Marco Barbanti et al. JACC Cardiovasc Interv. 2020 Nov 9;13(21):2542-2555. doi: 10.1016/j.jcin.2020.07.006.
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