Fractional flow reserve in patients with coronary artery disease undergoing TAVI: a prospective analysis
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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.
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.
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).
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.
KeywordsAortic valve stenosis TAVI Coronary artery disease Myocardial revascularization Fractional flow reserve FFR
Aortic valve stenosis
Coronary artery disease
Fractional flow reserve
Percutaneous coronary intervention
Quantitative coronary analysis
Surgical aortic valve replacement
Transcatheter aortic valve implantation
Transcatheter heart valve
Valve Academic Research Consortium
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.
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