Technical Considerations and Feasibility of Coronary Angiography and Percutaneous Coronary Intervention after CoreValve® Transcatheter Aortic Valve Implantation

ABSTRACT

Background: Review of the literature reveals difficulties re-engaging the coronary ostia after transcatheter aortic valve implantation (TAVI) with the CoreValve^® device (Medtronic Inc., Minneapolis, MN, USA) due to its design and potential interference with diagnostic or interventional catheters. Our objective was to evaluate the feasibility and technical considerations of coronary procedures in these patients.

Methods: Between October 2011 and November 2016, 573 patients underwent CoreValve TAVI at our hospital. Of these, 20 patients subsequently underwent 24 coronary procedures at our institution after TAVI and were included in this single-center retrospective analysis. Cardiac catheterization records and angiographic images were reviewed to evaluate for successful engagement of the coronary ostia and adequate angiographic result.

Results: The left main was selectively engaged in 18 of 23 cases (79%) and subselectively engaged with good angiographic result in four cases (16%). The right coronary artery (RCA) was selectively engaged in three of 12 cases (25%) and subselectively engaged with good angiographic result in eight cases (64%). An average of 1.4 ± 0.9 catheters were needed to engage each coronary ostia. Compared to pre-TAVI coronary procedures, selective engagement of the RCA occurred less frequently post-TAVI (25% vs. 85%, p = 0.0048).

Conclusions: Coronary procedures are feasible and successful in the majority of patients with pre-existing CoreValve TAVI. However, selective engagement of the RCA ostium was particularly more difficult to achieve post-TAVI. The implications of challenging coronary engagement requires further study, given that TAVI rates are expected to rise and expand to a younger demographic.

KEYWORDS:

• Coronary angiography
• left heart catheterization
• Medtronic CoreValve^®
• percutaneous coronary intervention
• transcatheter aortic valve implantation

Disclosure statements

Dr. Jeroudi and Dr. Rehman have no conflicts of interest to report. Dr. Barker is a member of the Medtronic Advisory Board.