Courtesy of Dr. Carlos Fava.

Between 40% and 70% of patients undergoing transcatheter aortic valve replacement (TAVR) present coronary lesions. The fact that aortic stenosis affects how blockages act, and that, after stenosis correction, hemodynamic compromise for those same lesions may vary, has been consistently proven. Its management has not been determined yet.

The study included 54 patients with 133 coronary lesions assessed by fractional flow reserve (FFR) before and after TAVR, in order to assess lesion interaction after aortic obstruction correction.

Overall, no differences were observed in FFR before and after TAVR. However, a separate analysis of the group presenting a baseline FFR <0.8 showed a reduction in this indicator after the procedure (0.71 ± 0.11 at baseline vs. 0.66 ± 0.14 after procedure; p <0.001).

Changes were also observed in a separate analysis of the group presenting a baseline FFR >0.8, which showed an increase after TAVR (0.92 ± 0.06 at baseline vs. 0.93 ± 0.07 after procedure; p <0.01).

In lesions with >50% stenosis, FRR was reduced after TAVR (0.84 ± 12 at baseline vs. 0.82 ± 0.16 after procedure; p = 0.02), while in intermediate lesions FRR tended to improve (0.90 ± 0.07 at baseline vs. 0.91 ± 0.09 after procedure).

Conclusion

Coronary artery flow changes after aortic stenosis correction. FFR variation is small after TAVR with a cutoff of 0.80. Intermediate lesions may become significant after TAVR in FFR-guided interventions.

Editorial

Many patients undergoing TAVR have lesions that seem to be non-severe or that do not evolve as ischemia. However, after TAVR, coronary hemodynamics are modified and such lesions may become significant.

Courtesy of Dr. Carlos Fava. Buenos Aires Favaloro Foundation, Argentina.

Original title: Functional Assessment of Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve Implantation: Influence of Pressure Overload on the Evaluation of Lesions Severity.

Reference: Gabriele Pesarini, et al.  Circ Cardiovasc Interv 2016;9:e004088.

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