Feasibility of coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement using a Medtronic™ self-expandable bioprosthetic valve.

Background And Objective: With aging, the progression of atherosclerosis in the coronary arteries is expected. The Medtronic™ self-expandable aortic bioprosthetic valve is deployed in the supra-annular position, and it has been challenging to selectively engage coronary arteries post-transcatheter aortic valve replacement (TAVR) even though there are diamond-shaped spaces in the mesh frame within the valve. Given the scarcity of data, we analyzed angiographic and clinical data from all patients requiring coronary angiography (CA) or intervention post-TAVR.

Methods: From January 2012 to December 2016, 403 patients were treated for severe aortic stenosis with TAVR at our center using the Medtronic™ self-expandable valve. This study included patients who underwent CA with or without percutaneous coronary intervention (PCI) after TAVR.

Results: Twenty-eight patients underwent 43 CAs after TAVR at our institution. Eleven patients (39%) were women. More than 90% of the procedures were performed for acute coronary syndrome. Thirty-six cases were performed using the transfemoral approach (83%). Forty-two of 43 (97%) left coronary arteries were selectively engaged, and 29 of 32 (90%) right coronary arteries were selectively engaged. We were able to engage 11 saphenous vein grafts and two left internal mammary artery grafts selectively (100%). The mean fluoroscopy time for diagnostic CA was 11.5 min, and for PCI, instantaneous wave-free ratio, or intravascular ultrasound (IVUS) interrogation, it was 19 minutes. The mean amount of contrast used for diagnostic CA was 102 cc per case, and for PCI, iFR, or IVUS, it was 146 cc per case. No periprocedural complication was noted.

Conclusions: CA with or without PCI after TAVR is feasible with supra-annular self-expandable valves. With the proper technique in experienced hands, it can be conducted safely.