Percutaneous Coronary Interventions in Patients With Prior Transcatheter Aortic Valve Replacement

BACKGROUND: Coronary access post-transcatheter aortic valve replacement (TAVR) can be challenging. We evaluated technical aspects of percutaneous coronary intervention (PCI) in patients post-TAVR. OBJECTIVES: The aim of the study was to assess the feasibility, technical aspects, and success rate of PCI in patients who have previously undergone TAVR. METHODS: We retrospectively evaluated data on patients undergoing PCI after TAVR focusing on the procedural and technical aspects of PCI. The primary endpoint was the technical success rate of PCI. RESULTS: Out of 2,298 patients undergoing TAVR, 44 (1.9%) underwent PCI (total 51 PCI cases) post-TAVR (39.2% after balloon-expandable, 60.8% after self-expanding transcatheter heart valve). Mean age was 76 ± 9.01 years; 39.2% were women. The median time-to-PCI post-TAVR was 25.92 ± 33.35 months. In almost a third of patients, indication for PCI was stable angina (35.3%), two-thirds had PCI for acute coronary syndrome (7.8% ST-segment elevation myocardial infarction, 39.2% non-ST-segment elevation myocardial infarction, and 17.6% unstable angina). Urgent PCI was performed in 64.7%. Predominant access route was femoral (88.2%). Selective guide catheter coronary engagement was possible in 86.3%, and guide catheter extension in 13.7%. Guidewire airmailing and use of guide extension catheter were required in 11.8%. Atherectomy was performed in 11.7%. PCI technical success was achieved in 96% (49/51 procedures). There was no difference in technical success in patients with balloon-expandable vs self-expanding TAVR (100% vs 93.5%; P = 0.25). CONCLUSIONS: Despite anatomical challenges posed by transcatheter heart valves, coronary access and PCI post-TAVR are highly successful when appropriate techniques are employed. As TAVR continues to expand to younger patients with longer life expectancy, operator familiarity with coronary access strategies will be essential to optimize post-TAVR care.