Feasibility of Coronary Access and Aortic Valve Reintervention in Low-Risk TAVR Patients |
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| Affiliation: | 1. Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC;2. Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland;3. Department of Cardiology, MedStar Washington Hospital Center, Washington, DC;4. Division of Cardiothoracic Surgery, MedStar Washington Hospital Center, Washington, DC;5. Division of Cardiology, The Miriam Hospital, Providence, Rhode Island;6. Division of Cardiothoracic Surgery, Lifespan Cardiovascular Institute, Providence, Rhode Island;7. Department of Medicine, The Valley Hospital, Ridgewood, New Jersey;8. Cardiac Surgery Program, The Valley Hospital, Ridgewood, New Jersey;9. Department of Cardiology, Henrico Doctors’ Hospital, Richmond, Virginia;10. Department of Cardiothoracic Surgery, Henrico Doctors’ Hospital, Richmond, Virginia;11. Department of Medicine, Stony Brook Hospital, Stony Brook, New York;12. Department of Surgery, Stony Brook Hospital, Stony Brook, New York;13. Cardiovascular Service Line, Maine Medical Center, Portland, Maine;14. St. John Heart Institute Cardiovascular Consultants, St. John Health System, Tulsa, Oklahoma;15. St. John Clinic Cardiovascular Surgery, St. John Heart Institute Cardiovascular Consultants, St. John Health System, Tulsa, Oklahoma;p. Foundation for Cardiovascular Medicine, Stanford University, Stanford, California;q. MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, DC |
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| Abstract: | ObjectivesThe aim of this study was to evaluate the feasibility of coronary access and aortic valve reintervention in low-risk patients undergoing transcatheter aortic valve replacement (TAVR) with a balloon-expandable transcatheter heart valve (THV).BackgroundYounger, low-risk TAVR patients are more likely than older, higher risk patients to require coronary angiography, percutaneous coronary intervention, or aortic valve reintervention, but their THVs may impede coronary access and cause coronary obstruction during TAVR-in-TAVR.MethodsThe LRT (Low Risk TAVR) trial (NCT02628899) enrolled 200 subjects with symptomatic severe aortic stenosis to undergo TAVR using commercially available THVs. Subjects who received balloon-expandable THVs and who had 30-day cardiac computed tomographic scans were included in this study. In a subgroup, the feasibility of intentional THV crimping on the delivery catheter to pre-determine commissural alignment was tested.ResultsIn the LRT trial, 168 subjects received balloon-expandable THVs and had 30-day cardiac computed tomographic scans, of which 137 were of adequate image quality for analysis. The most challenging anatomy for coronary access (THV frame above and commissural suture post in front of a coronary ostium) was observed in 9% to 13% of subjects. Intentional THV crimping did not appear to meaningfully affect commissural alignment. The THV frame extended above the sinotubular junction in 21% of subjects, and in 13%, the distance between the THV and the sinotubular junction was <2 mm, signifying that TAVR-in-TAVR may not be feasible without causing coronary obstruction.ConclusionsTAVR may present challenges to future coronary access and aortic valve reintervention in a substantial number of low-risk patients. |
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| Keywords: | coronary access coronary artery obstruction percutaneous coronary intervention transcatheter aortic valve replacement valve-in-valve CAD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" coronary artery disease CT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" computed tomographic LRT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" Low Risk TAVR PCI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" percutaneous coronary intervention STJ" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" sinotubular junction TAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" transcatheter aortic valve replacement THV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" transcatheter heart valve |
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