Coronary Angiography and Percutaneous Coronary Intervention After Transcatheter Aortic Valve Replacement |
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Authors: | Matias B Yudi Samin K Sharma Gilbert HL Tang Annapoorna Kini |
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Institution: | 1. Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York;2. Department of Cardiovascular Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York |
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Abstract: | Transcatheter aortic valve replacement (TAVR) has revolutionized the management of patients with symptomatic severe aortic stenosis, and indications are expanding towards treating younger patients with lower-risk profiles. Given the progressive nature of coronary artery disease and its high prevalence in those with severe aortic stenosis, coronary angiography and percutaneous coronary intervention will become increasingly necessary in patients after TAVR. There are some data suggesting that there are technical difficulties with coronary re-engagement, particularly in patients with self-expanding valves that, by design, extend above the coronary ostia. The authors review the challenges of coronary angiography and percutaneous coronary intervention post-TAVR and examine the geometric interactions between currently approved transcatheter aortic valves and coronary ostia, while providing a practical guide on how to manage these potentially complex situations. |
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Keywords: | aortic stenosis aortic valve cardiac catheterization coronary artery disease AR Amplatz right AS aortic stenosis CAD coronary artery disease CI confidence interval CT computed tomography JL Judkins left JR Judkins right LCA left coronary artery MACE major adverse cardiovascular events MI myocardial infarction PCI percutaneous coronary intervention RCA right coronary artery SS SYNTAX score STJ sinotubular junction TAVR transcatheter aortic valve replacement |
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