Use of Non-Invasive Coronary Artery Assessment in Transcatheter Aortic Valve Replacement, A Feasibility Study

Abstract

Transcatheter aortic valve replacement (TAVR) is increasing in use of management of aortic valve disease, especially in elderly and co-morbid patients. Traditionally, invasive assessment of coronary arteries is recommended peri-procedurally in these patients. Non-invasive computerised tomography (CT) imaging may be sufficient in evaluating prognostically significant coronary disease in these patients. This feasibility study aimed to compare the use of CT imaging to invasive assessment of prognostically significant coronary disease in TAVR patients. CT imaging and invasive coronary angiography were compared in TAVR patients at the Princess Alexandra Hospital (PAH) from 2016 to present. Prognostically significant (left main coronary artery or proximal large vessel disease) coronary disease will be independently evaluated by cardiologists and compared between CT imaging and invasive coronary angiography. A total of 244 patients were included in the analysis, 136 of these were male. They had a mean age of 80.3±5.5yrs and a mean EURO II surgical risk score of 4.6±4.4%. Utilising CT imaging 2 patients proceeded to TAVR without undergoing invasive coronary artery assessment. Although only preliminary, this feasibility study shows that CT imaging holds the potential to exclude prognostically significant coronary artery disease in TAVR patients, reducing the risks associated with invasive coronary angiography in these patients.