Abstract 15025: Impact of Type of Transcatheter Heart Valve and Anatomic Features on Complexity of Percutaneous Coronary Intervention in Patients After Transcatheter Aortic Valve Replacement

Abstract

Introduction: Approximately half of the patients with severe aortic valve stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) present with concomitant coronary artery disease (CAD). Percutaneous coronary intervention (PCI) after TAVR is gaining increasing importance. Consequently, we investigated the factors that influence PCI procedures in patients following TAVR. Methods: We included consecutive 633 patients with severe aortic stenosis who underwent TAVR at our institution from 2016-2022. The primary endpoint was the time from puncture to initial coronary angiography. Results: The median age was 84 (81 - 87) years old, 39% were male, and 173 (27.3%) had concomitant coronary artery disease. Of these, 39 (22.2%) were treated conservatively, 22 (12.5%) underwent coronary artery bypass and TAVR, 64 (36.5%) underwent PCI before TAVR, and 46 (26.2%) underwent PCI after TAVR. The success rate of PCI after TAVR was 100% for both types of valves. The median initial angiography time from puncture was 16.2 minutes (10.6 - 29.1), significantly longer in the Self-expandable valve (SEV) group [22.0 minutes (14.1 - 59.2)] compared to the Balloon-expandable (BEV) group [14.9 minutes (8.1 - 21.1)] (p = 0.026). PCI to the right coronary artery [29.0 min (17.2 - 49.5)] took significantly longer than PCI to the left coronary artery [14.0 min (8.0 - 18.1)] (p = 0.001). Conversely, there was no significant association with CT measurements such as aortic angle, annulus area, coronary height, or valve size, and transcatheter heart valve size (p > 0.05). Factors that predicted difficulty in engaging coronary arteries (>30 min from puncture to first contrast) were SEV [odds ratio 6.4, 95% confidence interval (1.2 - 38.2), p = 0.024], RCA [odds ratio 6.0, 95% confidence interval (1.3 - 33.4), p = 0.020]. Conclusions: Despite the high completion rate of PCI after TAVR, the use of SEV and the approach to the right coronary artery can pose challenges.