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Fractional flow reserve in patients with coronary artery disease undergoing TAVI: a prospective analysis

  • Anja Stundl
  • Jasmin Shamekhi
  • Svenja Bernhardt
  • Maximilian Starke
  • Baravan Al-Kassou
  • Marcel Weber
  • Alexander Sedaghat
  • Hendrik Treede
  • Eberhard Grube
  • Georg Nickenig
  • Nikos Werner
  • Jan-Malte SinningEmail author
Original Paper
  • 44 Downloads

Abstract

Objectives

To determine the true prevalence of CAD in AS patients, to detect changes of the hemodynamic significance of coronary lesions following TAVI, to explore to what extent FFR-positive CAD might influence outcome and finally to develop a management algorithm for this patient subset.

Methods

From May 2016 to March 2018, diagnostic coronary angiography was performed in 246 patients before TAVI. In the presence of coronary lesions with a diameter stenosis ≥ 50%, FFR was measured. In patients with positive FFR ≤ 0.80, a control angiography was performed 6–8 weeks after TAVI.

Results

The study cohort was 81.0 ± 6.1 years old, 48.4% of the patients were male. 53.3% had concomitant CAD. 35.9% of these patients underwent PCI before TAVI due to functionally significant left main CAD and/or severe stenosis ≥ 90%. 31 patients underwent FFR measurements in cumulative 38 coronary lesions. Prior to TAVI, a negative FFR could be detected in 18 lesions, whereas a positive FFR was found in entirely 20 lesions. A control angiography and FFR measurement was performed in cumulative 13 lesions. Comparing the FFR values, there was no significant difference (0.77 ± 0.04 vs. 0.76 ± 0.08; p = 0.11).

Conclusion

Concomitant CAD was diagnosed in 53.3% of TAVI patients. FFR did not significantly change after TAVI, confirming the validity of FFR to evaluate coronary lesions in this specific clinical setting. Given the low rates of cardiac adverse events, it might therefore be considered to treat coronary stenoses not involving left main and those with a diameter stenosis < 90% after TAVI.

Keywords

Aortic valve stenosis TAVI Coronary artery disease Myocardial revascularization Fractional flow reserve FFR 

Abbreviations

AS

Aortic valve stenosis

CAD

Coronary artery disease

FFR

Fractional flow reserve

PCI

Percutaneous coronary intervention

QCA

Quantitative coronary analysis

SAVR

Surgical aortic valve replacement

TAVI

Transcatheter aortic valve implantation

TEE

Transesophageal echocardiography

THV

Transcatheter heart valve

VARC

Valve Academic Research Consortium

Notes

Compliance with ethical standards

Conflict of interest

Drs. Sinning, Grube, Nickenig, and Werner receive research grants and speaker honoraria from Medtronic and Edwards Lifesciences. Dr. Grube works as proctor for Medtronic. The other authors report no conflicts.

Supplementary material

392_2019_1563_MOESM1_ESM.docx (15 kb)
Supplementary file1 (DOCX 14 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Anja Stundl
    • 1
  • Jasmin Shamekhi
    • 1
  • Svenja Bernhardt
    • 1
  • Maximilian Starke
    • 1
  • Baravan Al-Kassou
    • 1
  • Marcel Weber
    • 1
  • Alexander Sedaghat
    • 1
  • Hendrik Treede
    • 2
  • Eberhard Grube
    • 1
  • Georg Nickenig
    • 1
  • Nikos Werner
    • 1
  • Jan-Malte Sinning
    • 1
    Email author
  1. 1.Heart Center Bonn, Department of Medicine IIUniversity Hospital BonnBonnGermany
  2. 2.Heart Center, Department of Cardiac SurgeryUniversity Hospital BonnBonnGermany

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