SPC365

Feasibility of Coronary Angiography after TAVR

Session: Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker: Gualter Santos Silva

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Posters
FP Number: ---
Authors: Gualter Santos Silva; Cláudio Espada Guerreiro; Pedro Gonçalves Teixeira; Pedro Ribeiro Queirós; Mariana Ribeiro da Silva; Mariana Brandão; Diogo Ferreira; Gustavo Pires-Morais; Lino Santos; Bruno Melica; Alberto Rodrigues; José Pedro Braga; Ricardo Fontes-Carvalho

<p style="text-align:justify"><span style="font-size:16px"><u><span style="font-family:Calibri,sans-serif"><strong>BACKGROUND</strong></span></u></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">The prevalence of coronary artery disease (CAD) is high among patients with severe aortic stenosis who undergo transcatheter aortic valve replacement (TAVR).&nbsp;Indications for TAVR are now expanding to younger and lower risk patients. During their lifetime, these patients will be at risk of developing CAD and it is expected an increase in coronary angiography and percutaneous coronary intervention (PCI). Aortic prosthesis, particularly if in supra-annular position, may pose important technical difficulties in coronary re-engagement after TAVR.</span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><u><span style="font-family:Calibri,sans-serif"><strong>OBJECTIVE</strong></span></u></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">To evaluate the feasibility to reengage the coronary ostia after TAVR, describe complications and compare technical differences between coronary procedures performed before and after TAVR.</span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif"><strong><u>METHODS</u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Retrospective analysis of 714 patients submitted to TAVR from August 2007 to December 2019. Patients who needed coronary angiography after TAVR were selected.&nbsp;The primary endpoint was the rate of successful coronary ostia cannulation after TAVR, defined by the possibility to selectively cannulate and inject both coronary ostia.&nbsp;Secondary endpoint was complications associated with coronary catheterization after TAR.</span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><u><span style="font-family:Calibri,sans-serif"><strong>RESULTS&nbsp;</strong></span></u></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Among 714 patients, a total of 25 (3.5%) patients were submitted to coronary angiography after TAVR. 14 patients were male (56%), mean age 78.2 <span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">&plusmn;</span> 6.2 years and 9 (36%) had history of previous coronary revascularization.&nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">From the 25 coronary angiographies (balloon-expandable Edwards-Sapien n=11, 44%; self-expandable CoreValve n=10, 40%; Portico n=2, 8%; Symetis n=2, 8%), 24 met the primary endpoint and only one was semiselective (in a patient with a Symetis). Among these, 12 (48%) had also indication for PCI and all were successfully performed (Edwards-Sapien n=3, 25%; CoreValve n=6, 50%; Portico n=2, 17%; Symetis n=1, 8%). The main indications for coronary angiography was chronic coronary syndrome (n=8, 32%) and acute coronary syndrome without ST segment elevation (n=7, 28%). Coronary arteries treated in this context were: left main 16.7% (n=2), anterior descending artery 33.3% (n=4), circumflex artery 41.7% (n=5) and right coronary artery 25.0% (n=3). </span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">There were no complications reported during or post-procedure. Comparing coronary angiographies before and after TAVR, there were no significant differences regarding arterial access site, catheter diameter, fluoroscopy time and quantity of contrast used in coronary angiography.</span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><u><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION&nbsp;</strong></span></u></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Although the need for coronary angiography was rare in patients after TAVR, selective diagnostic coronary angiographies were possible in 96% (24/25) and PCI was feasible in all patients in whom it was indicated, without any reported complications.&nbsp;Further prospective studies are needed to confirm the great feasibility of performing coronary angiography after TAVR.</span></span></p>