Low rate of invasive coronary angiography following transcatheter aortic valve implantation: Real-world prospective cohort findings

Aim: To evaluate the real need for coronary access after transcatheter aortic valve implantation (TAVI). Methods and results: Prospective observational single center registry, including 563 consecutive patients that underwent TAVI between April 2008 and November 2018, with both self and balloon expandable valves in a tertiary European center. Mean age was 82.4 ± 6.9 years, 53.3% were female, 16% had previous history of CABG, 33% of previous PCI and 16.6% of MI. Twenty four percent of the patients were revascularized within one year before TAVI in preparation for the procedure. Median STS Score was 4.82 (IQ 2.84). In a median follow up of 24 months (IQ 21.5), 18 patients (3.2%) were identified as potentially in need for ICA: 9 (1.6%) in the setting of stable coronary artery disease and 9 (1.6%) for an acute coronary syndrome. A total of 11 PCI were performed in 9 patients, with a complete success rate of 63.6%. Procedures that were unsuccessful or partially unsuccessful were due to the inability to cross the stent or the drug eluting balloon through the valve struts or misplacement within the coronary artery due to lack of catheter's support. Conclusion: In this population, a strategy of previous guideline guided revascularization before transcatheter aortic valve implantation was associated with a low rate of myocardial infarction and repeated need of coronary access, with a scattered distribution over time. Assuring future access to coronary arteries in patients at increased risk may depend on the revascularization strategy rather than device selection.