Is Angioplasty Always Necessary after TAVR?

Courtesy of: Silvina E. Gomez, MD

The prevalence of coronary artery disease (CAD) in patients undergoing TAVR is high, ranging from 40 to 70%, according to different series. However, its prognostic impact in this context has not yet been fully elucidated and the benefit of angioplasty before, during or after procedure still stands unanswered. This is due, in part, to the fact that post implantation coronary artery catheterization is often more complex and challenging. 

This analysis of the France-TAVI Registry included 64,660 patients, 41.266 (63,8%) receiving balloon expandable valves (BEV). These included SAPIEN XT and SAPIEN 3, while the self-expanding (SEV) were CoreValve, Evolut, Evolut R and Evolut Pro.

The primary outcome was incidence rehospitalization for cardiovascular events (CE).

Mean population age was 83, and 51% were men, with mean EuroScore 12. The groups were similar, though BEV patients had higher prevalence of prior coronary artery disease, cardiac surgery and peripheral vascular disease. 

88% of procedures were femoral. 

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The primary outcome resulted more frequent among BEV patients (12% [11,7%-12,3%] vs. 11,0% [10,5%-11,4%]; P = 0.04). There were no significant differences in the presence of acute coronary syndromes, though the number of angioplasty procedures (PCI) was higher among BEV patients (5,4% [5,2%-5,6%] vs. 3,6% [3,4%-3,9%]; P < 0.001).

Annual cardiovascular event rate resulted low (1.5% per year).

The main predictors of cardiovascular events were: male sex, younger age, dyslipidemia, known CAD, peripheral vascular disease and coronary lesions >50%, while valve type showed no significant correlation with cardiovascular events. 

Also, cardiovascular patients admitted to centers were TAVR was performed had higher chances of receiving PCI. 

Conclusion

The annual incidence of cardiovascular events after TAVR is low. However, patients not receiving PCI presented less favorable evolution. Self-expandable valves are associated to poor evolution and a lower chance of receiving PCI, especially when patients were admitted to centers which did not perform TAVR. 

Original Title: Coronary Events After Transcatheter Aortic Valve Replacement. Insights From the France TAVI Registry.

Reference: Sandra Zendjebil, et al JACC: JANUARY 27 doi.org/10.1016/j.jcin.2024.09.005.