SPC365

Low rate of invasive coronary angiography following transcatheter aortic valve implantation: Real-world Prospective Cohort findings

Session: CO 24 - Interventional Cardiology -TAVI
Speaker: Rita Reis Santos

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Comunicações Orais
FP Number: ---
Authors: Rita Reis Santos ; Mariana Gonçalves; Pedro de Araújo Gonçalves; Rui Campante Teles; Manuel de Sousa Almeida; Mariana Sousa Paiva; Afonso Félix de Oliveira; João Brito; Luís Raposo; Henrique Mesquita Gabriel; Tiago Nolasco; José Pedro Neves; Miguel Mendes

<p style="text-align:justify"><strong>Introduction:</strong> Coronary artery disease is prevalent among patients with severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) procedures are increasing at a high rate. Revascularization strategies before TAVI differ and concerns about future coronary intervention influence strategy and device selection.&nbsp;Intraprocedural need for coronary access is a major concern and coronary ostial obstruction due to valve leaflets or calcium displacement can be as high as 0.8%&nbsp;and 3.5% when valve-in-valve procedures are accounted. With the increasing number of procedures, coronary access can become a challenge for interventional cardiology operators and so, real world data about the incidence of acute coronary events after TAVI, the need for coronary reassessment and success rate of consequential procedures should be shared.</p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim:</strong></span></span></span><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> To evaluate the real need for coronary access after transcatheter aortic valve implantation (TAVI).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods and Results: </strong></span></span></span><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Prospective observational single center registry, including 563 consecutive patients that underwent TAVI between April 2008 and November 2018, with both self and balloon expandable valves in a tertiary European center. Mean age was 82.4 &plusmn; 6.9 years, 53.3% were female, 16% had previous history of CABG, 33% of previous PCI and 16.6% of MI. Twenty four percent of the patients were revascularized within one year before TAVI in preparation for the procedure. Median STS Score was 4.82 (IQ 2.84).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">&nbsp;In a median follow up of 24 months (IQ 21.5), 18 patients (3.2%) were identified as potentially in need for ICA: 9 (1.6%) in the setting of stable coronary artery disease and 9 (1.6%) for an acute coronary syndrome.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">&nbsp;A total of 11 PCI were performed in 9 patients, with a complete success rate of 63.6%. </span></span></span><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"><span style="background-color:#ffffff">Procedures that were unsuccessful or partially unsuccessful were due to the inability</span></span></span></span><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> to cross the stent or the drug eluting balloon through the valve struts or misplacement within the coronary artery due to lack of catheter&rsquo;s support.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong></span></span></span><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In this population, a strategy of previous guideline guided revascularization before transcatheter aortic valve implantation (TAVI) was associated with a low rate of myocardial infarction and repeated need of coronary access, with a scattered distribution over time. Assuring future access to coronary arteries in patients at increased risk may depend on the revascularization strategy rather than device selection.</span></span></span></p>