SPC365

Through the Mesh: Coronary Access After TAVI

Session: Sessão de Posters 26 - Implantação transcateter da válvula aórtica (TAVI): desfechos, complicações e biomarcadores
Speaker: Joao Santos Fonseca

Congress: CPC 2026
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.7 Valvular Heart Disease - Other
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Joao Santos Fonseca; Marta Vilela; Daniel Cazeiro; Diogo Ferreira; Joao Fernandes Pedro; Sofia Esteves; Claudia Jorge; Miguel Nobre Menezes; Joao Silva Marques; Pedro Cardoso; Fausto J. Pinto; Pedro Carrilho Ferreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Introduction</span></span></strong><br />
<span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Transcatheter aortic valve implantation (TAVI) has become a standard treatment for severe aortic stenosis in patients over 75 years. As survival improves, the need for coronary angiography (CA) and percutaneous coronary intervention (PCI) after TAVI is increasing. However, the procedure may be technically challenging due to valve design and positioning.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Aim:</span></span></strong><br />
<span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">To evaluate the feasibility, procedural characteristics, and outcomes of coronary angiography and PCI performed after TAVI.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Methods:</span></span></strong><br />
<span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Retrospective, single-center study of consecutive patients who underwent CA (with or without PCI) after TAVI. Demographic characteristics, procedural data, type of previously implanted valves and catheters used in the CA were collected from patients&rsquo; records. Procedural times and radiation and contrast doses were compared with a control group of 100 age-matched patients without transcatheter heart valves who underwent diagnostic CA.&nbsp; Finally, success rates of catheterization (defined as selective, nonselective and unsuccessful catheterization) were analyzed according to each valve family (Evolut&reg;, Sapien&reg;, Navitor&reg; and Acurate&reg;).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Results:</span></span></strong><br />
<span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Among 1418 patients who underwent TAVI in the study period, a total of 37 patients (median age 83 years, 54% male) underwent CA in our institution. Of those, 3 (8%) patients underwent coronary physiology assessment, and 19 (51%) patients required PCI (21 vessels). One of the patients had been submitted to TAVI in another centre.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Overall median procedure time, fluoroscopy time, radiation dose, and contrast volume were 56 min, 16 min, 1073 mGy, and 153 mL, respectively. Compared with controls, TAVI patients who underwent diagnostic CA had significantly longer procedural (35 vs 21 min, p=0.015) and fluoroscopy times (7 vs 4 min, p=0.001), and higher radiation (494 vs 203 mGy, p&lt;0.001) and contrast doses (81 vs 59mL, p=0.006).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">LCA catheterization was successful in 100% of patients (89% selective), while RCA catheterization success was 94% (79% selective). The Judkins left and right catheters were the most frequently utilized, and no additional catheters were required for diagnostic CA. PCI success rate was 76%, with unsuccessful catheterization accounting for only one failure. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">The Evolut valve family was associated with the highest rate of nonselective or failed catheterizations (OR 9.6 [1.45&ndash;63.5], p=0.019).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Conclusion:</span></span></strong><br />
<span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Coronary angiography after TAVI is feasible, although associated with longer procedural times and greater radiation exposure. The Evolut valve design may present increased challenges for selective coronary engagement, emphasizing the importance of valve selection and procedural planning in patients who may potentially require future coronary access.</span></span></span></span></p>