Strategies and research status of coronary access for percutaneous coronary intervention after transcatheter aortic valve replacement_West China Medical Journal

Authors：

AN Chunjuan ^1,2 , FANG Yi ² , WANG Bin ² , HAN Yaling ² ,  XU Kai ²

1. The Graduate School , Jinzhou Medical University, Jinzhou, Liaoning 121011, P. R. China;
2. Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P. R. China;

Corresponding author：

XU Kai, Email: xukai2001@sina.com

Keywords：

Transcatheter aortic valve replacement; aortic stenosis; percutaneous coronary intervention

DOI：

10.7507/1002-0179.202210058

Video：

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As the indications for transcatheter aortic valve replacement (TAVR) expand to low-risk young patients, the number of patients undergoing percutaneous coronary intervention (PCI) after one or more TAVR may increase. The coronary access for PCI after TAVR has become a very practical and severe problem. Coronary re-intervention poses technical difficulties, and compared to balloon expandable valve, the use of self-expanding valve is more challenging for the coronary access for PCI after TAVR. This article discusses the selection of appropriate valves before TAVR, the implementation of intraoperative commissural alignment technology, and the techniques for mastering the coronary access for PCI after TAVR, in order to improve the success rate of the coronary access for PCI after TAVR.

Citation： AN Chunjuan, FANG Yi, WANG Bin, HAN Yaling, XU Kai. Strategies and research status of coronary access for percutaneous coronary intervention after transcatheter aortic valve replacement. West China Medical Journal, 2023, 38(9): 1303-1308. doi: 10.7507/1002-0179.202210058 Copy

1.	Boukantar M, Gallet R, Mouillet G, et al. Coronary procedures after TAVI with the self-expanding aortic bioprosthesis medtronic CoreValve^TM, not an easy matter. J Interv Cardiol, 2017, 30(1): 56-62.
2.	Blumenstein J, Kim WK, Liebetrau C, et al. Challenges of coronary angiography and intervention in patients previously treated by TAVI. Clin Res Cardiol, 2015, 104(8): 632-639.
3.	Htun WW, Grines C, Schreiber T. Feasibility of coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement using a Medtronic^TM self-expandable bioprosthetic valve. Catheter Cardiovasc Interv, 2018, 91(7): 1339-1344.
4.	Allali A, El-Mawardy M, Schwarz B, et al. Incidence, feasibility and outcome of percutaneous coronary intervention after transcatheter aortic valve implantation with a self-expanding prosthesis. Results from a single center experience. Cardiovasc Revasc Med, 2016, 17(6): 391-398.
5.	Arshi A, Yakubov SJ, Stiver KL, et al. Overcoming the transcatheter aortic valve replacement achilles heel: coronary re-access. Ann Cardiothorac Surg, 2020, 9(6): 468-477.
6.	Yudi MB, Sharma SK, Tang GHL, et al. Coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement. J Am Coll Cardiol, 2018, 71(12): 1360-1378.
7.	Nai Fovino L, Badawy MRA, Fraccaro C, et al. Transfemoral aortic valve implantation with new-generation devices: the repositionable Lotus vs. the balloon-expandable Edwards Sapien 3 valve. J Cardiovasc Med (Hagerstown), 2018, 19(11): 655-663.
8.	Tang GHL, Zaid S, Ahmad H, et al. Transcatheter valve neo-commissural overlap with coronary orifices after transcatheter aortic valve replacement. Circ Cardiovasc Interv, 2018, 11(10): e007263.
9.	Katsanos S, Debonnaire P, van der Kley F, et al. Position of Edwards SAPIEN transcatheter valve in the aortic root in relation with the coronary ostia: implications for percutaneous coronary interventions. Catheter Cardiovasc Interv, 2015, 85(3): 480-487.
10.	Tarantini G, Nai Fovino L, Scotti A, et al. Coronary access after transcatheter aortic valve replacement with commissural alignment: the ALIGN-ACCESS study. Circ Cardiovasc Interv, 2022, 15(2): e011045.
11.	Ochiai T, Chakravarty T, Yoon SH, et al. Coronary access after TAVR. JACC Cardiovasc Interv, 2020, 13(6): 693-705.
12.	Caudron J, Fares J, Hauville C, et al. Evaluation of multislice computed tomography early after transcatheter aortic valve implantation with the Edwards SAPIEN bioprosthesis. Am J Cardiol, 2011, 108(6): 873-881.
13.	Dumonteil N, Marcheix B, Lairez O, et al. Transcatheter aortic valve implantation for severe, non-calcified aortic regurgitation and narrow aortic root: description from a case report of a new approach to potentially avoid coronary artery obstruction. Catheter Cardiovasc Interv, 2013, 82(2): E124-E127.
14.	Fuchs A, Kofoed KF, Yoon SH, et al. Commissural alignment of bioprosthetic aortic valve and native aortic valve following surgical and transcatheter aortic valve replacement and its impact on valvular function and coronary filling. JACC Cardiovasc Interv, 2018, 11(17): 1733-1743.
15.	Tang GHL, Zaid S, Gupta E, et al. Impact of initial evolut transcatheter aortic valve replacement deployment orientation on final valve orientation and coronary reaccess. Circ Cardiovasc Interv, 2019, 12(7): e008044.
16.	Tang GHL, Zaid S, Fuchs A, et al. Alignment of transcatheter aortic-valve neo-commissures (ALIGN TAVR): impact on final valve orientation and coronary artery overlap. JACC Cardiovasc Interv, 2020, 13(9): 1030-1042.
17.	Wang X, De Backer O, Bieliauskas G, et al. Cusp symmetry and coronary ostial eccentricity and its impact on coronary access following TAVR. JACC Cardiovasc Interv, 2022, 15(2): 123-134.
18.	Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
19.	Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
20.	Tarantini G, Nai Fovino L, Le Prince P, et al. Coronary access and percutaneous coronary intervention up to 3 years after transcatheter aortic valve implantation with a balloon-expandable valve. Circ Cardiovasc Interv, 2020, 13(7): e008972.
21.	Khan M, Senguttuvan NB, Krishnamoorthy P, et al. Coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement with medtronic self-expanding prosthesis: Insights from correlations with computer tomography. Int J Cardiol, 2020, 317: 18-24.
22.	Ferreira-Neto AN, Puri R, Asmarats L, et al. Clinical and technical characteristics of coronary angiography and percutaneous coronary interventions performed before and after transcatheter aortic valve replacement with a balloon-expandable valve. J Interv Cardiol, 2019, 2019: 3579671.
23.	陈姣华, 李捷, 孙英皓, 等. 合并冠心病的经导管主动脉瓣置换术患者管理及处理策略. 心电与循环, 2022, 41(1): 26-31.
24.	Jackson M, Williams PD. Coronary access following TAVI - selective coronary engagement using balloon-assisted tracking of a guide catheter extension. Cardiovasc Revasc Med, 2018, 19(3 Pt B): 384-389.
25.	De Backer O, Landes U, Fuchs A, et al. Coronary access after TAVR-in-TAVR as evaluated by multidetector computed tomography. JACC Cardiovasc Interv, 2020, 13(21): 2528-2538.
26.	Meier D, Akodad M, Landes U, et al. Coronary access following redo TAVR: impact of THV design, implant technique, and cell misalignment. JACC Cardiovasc Interv, 2022, 15(15): 1519-1531.
27.	Dvir D, Webb J, Brecker S, et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry. Circulation, 2012, 126(19): 2335-2344.
28.	Tchétché D, Chevalier B, Holzhey D, et al. TAVR for failed surgical aortic bioprostheses using a self-expanding device: 1-year results from the prospective VIVA postmarket study. JACC Cardiovasc Interv, 2019, 12(10): 923-932.
29.	Ribeiro HB, Rodés-Cabau J, Blanke P, et al. Incidence, predictors, and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: insights from the VIVID registry. Eur Heart J, 2018, 39(8): 687-695.
30.	Medranda GA, Soria Jimenez CE, Torguson R, et al. Lifetime management of patients with symptomatic severe aortic stenosis: a computed tomography simulation study. EuroIntervention, 2022, 18(5): e407-e416.

1. Boukantar M, Gallet R, Mouillet G, et al. Coronary procedures after TAVI with the self-expanding aortic bioprosthesis medtronic CoreValve^TM, not an easy matter. J Interv Cardiol, 2017, 30(1): 56-62.
2. Blumenstein J, Kim WK, Liebetrau C, et al. Challenges of coronary angiography and intervention in patients previously treated by TAVI. Clin Res Cardiol, 2015, 104(8): 632-639.
3. Htun WW, Grines C, Schreiber T. Feasibility of coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement using a Medtronic^TM self-expandable bioprosthetic valve. Catheter Cardiovasc Interv, 2018, 91(7): 1339-1344.
4. Allali A, El-Mawardy M, Schwarz B, et al. Incidence, feasibility and outcome of percutaneous coronary intervention after transcatheter aortic valve implantation with a self-expanding prosthesis. Results from a single center experience. Cardiovasc Revasc Med, 2016, 17(6): 391-398.
5. Arshi A, Yakubov SJ, Stiver KL, et al. Overcoming the transcatheter aortic valve replacement achilles heel: coronary re-access. Ann Cardiothorac Surg, 2020, 9(6): 468-477.
6. Yudi MB, Sharma SK, Tang GHL, et al. Coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement. J Am Coll Cardiol, 2018, 71(12): 1360-1378.
7. Nai Fovino L, Badawy MRA, Fraccaro C, et al. Transfemoral aortic valve implantation with new-generation devices: the repositionable Lotus vs. the balloon-expandable Edwards Sapien 3 valve. J Cardiovasc Med (Hagerstown), 2018, 19(11): 655-663.
8. Tang GHL, Zaid S, Ahmad H, et al. Transcatheter valve neo-commissural overlap with coronary orifices after transcatheter aortic valve replacement. Circ Cardiovasc Interv, 2018, 11(10): e007263.
9. Katsanos S, Debonnaire P, van der Kley F, et al. Position of Edwards SAPIEN transcatheter valve in the aortic root in relation with the coronary ostia: implications for percutaneous coronary interventions. Catheter Cardiovasc Interv, 2015, 85(3): 480-487.
10. Tarantini G, Nai Fovino L, Scotti A, et al. Coronary access after transcatheter aortic valve replacement with commissural alignment: the ALIGN-ACCESS study. Circ Cardiovasc Interv, 2022, 15(2): e011045.
11. Ochiai T, Chakravarty T, Yoon SH, et al. Coronary access after TAVR. JACC Cardiovasc Interv, 2020, 13(6): 693-705.
12. Caudron J, Fares J, Hauville C, et al. Evaluation of multislice computed tomography early after transcatheter aortic valve implantation with the Edwards SAPIEN bioprosthesis. Am J Cardiol, 2011, 108(6): 873-881.
13. Dumonteil N, Marcheix B, Lairez O, et al. Transcatheter aortic valve implantation for severe, non-calcified aortic regurgitation and narrow aortic root: description from a case report of a new approach to potentially avoid coronary artery obstruction. Catheter Cardiovasc Interv, 2013, 82(2): E124-E127.
14. Fuchs A, Kofoed KF, Yoon SH, et al. Commissural alignment of bioprosthetic aortic valve and native aortic valve following surgical and transcatheter aortic valve replacement and its impact on valvular function and coronary filling. JACC Cardiovasc Interv, 2018, 11(17): 1733-1743.
15. Tang GHL, Zaid S, Gupta E, et al. Impact of initial evolut transcatheter aortic valve replacement deployment orientation on final valve orientation and coronary reaccess. Circ Cardiovasc Interv, 2019, 12(7): e008044.
16. Tang GHL, Zaid S, Fuchs A, et al. Alignment of transcatheter aortic-valve neo-commissures (ALIGN TAVR): impact on final valve orientation and coronary artery overlap. JACC Cardiovasc Interv, 2020, 13(9): 1030-1042.
17. Wang X, De Backer O, Bieliauskas G, et al. Cusp symmetry and coronary ostial eccentricity and its impact on coronary access following TAVR. JACC Cardiovasc Interv, 2022, 15(2): 123-134.
18. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
19. Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
20. Tarantini G, Nai Fovino L, Le Prince P, et al. Coronary access and percutaneous coronary intervention up to 3 years after transcatheter aortic valve implantation with a balloon-expandable valve. Circ Cardiovasc Interv, 2020, 13(7): e008972.
21. Khan M, Senguttuvan NB, Krishnamoorthy P, et al. Coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement with medtronic self-expanding prosthesis: Insights from correlations with computer tomography. Int J Cardiol, 2020, 317: 18-24.
22. Ferreira-Neto AN, Puri R, Asmarats L, et al. Clinical and technical characteristics of coronary angiography and percutaneous coronary interventions performed before and after transcatheter aortic valve replacement with a balloon-expandable valve. J Interv Cardiol, 2019, 2019: 3579671.
23. 陈姣华, 李捷, 孙英皓, 等. 合并冠心病的经导管主动脉瓣置换术患者管理及处理策略. 心电与循环, 2022, 41(1): 26-31.
24. Jackson M, Williams PD. Coronary access following TAVI - selective coronary engagement using balloon-assisted tracking of a guide catheter extension. Cardiovasc Revasc Med, 2018, 19(3 Pt B): 384-389.
25. De Backer O, Landes U, Fuchs A, et al. Coronary access after TAVR-in-TAVR as evaluated by multidetector computed tomography. JACC Cardiovasc Interv, 2020, 13(21): 2528-2538.
26. Meier D, Akodad M, Landes U, et al. Coronary access following redo TAVR: impact of THV design, implant technique, and cell misalignment. JACC Cardiovasc Interv, 2022, 15(15): 1519-1531.
27. Dvir D, Webb J, Brecker S, et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry. Circulation, 2012, 126(19): 2335-2344.
28. Tchétché D, Chevalier B, Holzhey D, et al. TAVR for failed surgical aortic bioprostheses using a self-expanding device: 1-year results from the prospective VIVA postmarket study. JACC Cardiovasc Interv, 2019, 12(10): 923-932.
29. Ribeiro HB, Rodés-Cabau J, Blanke P, et al. Incidence, predictors, and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: insights from the VIVID registry. Eur Heart J, 2018, 39(8): 687-695.
30. Medranda GA, Soria Jimenez CE, Torguson R, et al. Lifetime management of patients with symptomatic severe aortic stenosis: a computed tomography simulation study. EuroIntervention, 2022, 18(5): e407-e416.

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