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Challenges of coronary angiography and intervention in patients previously treated by TAVI

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Abstract

Objective

Since the beginning of the transcatheter aortic valve implantation (TAVI) era, many prosthetic valves have entered clinical practice. TAVI prostheses differ regarding stent design and some may potentially interfere with diagnostic or interventional catheters. The aim of our analysis was to evaluate the feasibility of coronary angiography (CA) or percutaneous coronary intervention (PCI) in patients with prior TAVI.

Methods

From 2011 to 2014, 1,000 patients were treated by TAVI at our center using eight different valve prostheses (Symetis ACURATE TA and ACURATE TF; Medtronic CoreValve and Engager; JenaValve, SJM Portico; Edwards Lifesciences SAPIEN and SAPIEN XT). In this analysis, all patients were included who underwent either CA or PCI after TAVI. CA or PCI were rated as fully feasible when coronary ostia could be fully intubated, partially feasible when coronary arteries could be displayed only unselectively or unfeasible when coronary arteries could not be displayed.

Results

A total of 35 patients underwent CA/PCI after TAVI at our hospital. In all patients with valves implanted in a subcoronary position (SAPIEN n = 19; JenaValve n = 1), selective intubation was feasible using standard catheters. Out of 15 patients with valve types that are placed over the coronary ostia (CoreValve n = 10, ACURATE n = 4, Portico n = 1), selective intubation of coronary arteries was not possible in 9 cases, even with the use of different diagnostic catheters. Full accessibility was possible only in 3 cases. In 2 cases, display of the right CA was only feasible using unselective aortography. In 1 case, coronary arteries could not be displayed at all immediately after a valve-in-valve procedure.

Conclusion

CA or PCI after TAVI is usually feasible. Devices that are placed in a partially supracoronary position, however, can interfere with diagnostic or guiding catheters and impede straightforward intervention, especially when the prosthesis is not implanted in the correct position.

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References

  1. Ielasi A, Latib A, Tespili M (2013) Current and new-generation transcatheter aortic valve devices: an update on emerging technologies. Expert Rev Cardiovasc Ther 11(10):1393–1405

    Article  CAS  PubMed  Google Scholar 

  2. Exadactylos N, Sugrue DD, Oakley CM (1984) Prevalence of coronary artery disease in patients with isolated aortic valve stenosis. Br Heart J 51(2):121–124

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Mohler ER 3rd (2000) Are atherosclerotic processes involved in aortic-valve calcification? Lancet 356(9229):524–525

    Article  PubMed  Google Scholar 

  4. Hamm CW, Mollmann H, Holzhey D, Beckmann A, Veit C, Figulla HR, Cremer J, Kuck KH, Lange R, Zahn R, Sack S, Schuler G, Walther T, Beyersdorf F, Bohm M, Heusch G, Funkat AK, Meinertz T, Neumann T, Papoutsis K, Schneider S, Welz A, Mohr FW (2013) The German Aortic Valve Registry (GARY): in-hospital outcome. Eur Heart J 35(24):1588–1598

    Article  PubMed Central  PubMed  Google Scholar 

  5. Conradi L, Seiffert M, Franzen O, Baldus S, Schirmer J, Meinertz T, Reichenspurner H, Treede H (2011) First experience with transcatheter aortic valve implantation and concomitant percutaneous coronary intervention. Clin Res Cardiol 100(4):311–316

    Article  PubMed  Google Scholar 

  6. Dewey TM, Brown DL, Herbert MA, Culica D, Smith CR, Leon MB, Svensson LG, Tuzcu M, Webb JG, Cribier A, Mack MJ (2010) Effect of concomitant coronary artery disease on procedural and late outcomes of transcatheter aortic valve implantation. Ann Thorac Surg 89(3):758–767 (discussion 767)

    Article  PubMed  Google Scholar 

  7. Antonini-Canterin F, Leiballi E, Capanna M, Burelli C, Cassin M, Macor F, Grandis U, Nicolosi GL (2009) Association between carotid and coronary artery disease in patients with aortic valve stenosis: an angiographic study. Angiology 60(5):596–600

    Article  PubMed  Google Scholar 

  8. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J 24(13):1231–1243

    Article  PubMed  Google Scholar 

  9. Gautier M, Pepin M, Himbert D, Ducrocq G, Iung B, Dilly MP, Attias D, Nataf P, Vahanian A (2011) Impact of coronary artery disease on indications for transcatheter aortic valve implantation and on procedural outcomes. EuroIntervention 7(5):549–555

    Article  PubMed  Google Scholar 

  10. Masson JB, Lee M, Boone RH, Al Ali A, Al Bugami S, Hamburger J, John Mancini GB, Ye J, Cheung A, Humphries KH, Wood D, Nietlispach F, Webb JG (2010) Impact of coronary artery disease on outcomes after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 76(2):165–173

    Article  PubMed  Google Scholar 

  11. Wenaweser P, Pilgrim T, Guerios E, Stortecky S, Huber C, Khattab AA, Kadner A, Buellesfeld L, Gloekler S, Meier B, Carrel T, Windecker S (2011) Impact of coronary artery disease and percutaneous coronary intervention on outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. EuroIntervention 7(5):541–548

    Article  PubMed  Google Scholar 

  12. Ussia GP, Barbanti M, Colombo A, Tarantini G, Petronio AS, Ettori F, Ramondo A, Santoro G, Klugmann S, Bedogni F, Antoniucci D, Maisano F, Marzocchi A, Poli A, De Carlo M, Fiorina C, De Marco F, Napodano M, Violini R, Bortone AS, Tamburino C (2013) Impact of coronary artery disease in elderly patients undergoing transcatheter aortic valve implantation: insight from the Italian CoreValve Registry. Int J Cardiol 167(3):943–950

    Article  PubMed  Google Scholar 

  13. Griese DP, Reents W, Toth A, Kerber S, Diegeler A, Babin-Ebell J (2014) Concomitant coronary intervention is associated with poorer early and late clinical outcomes in selected elderly patients receiving transcatheter aortic valve implantation. Eur J Cardiothorac Surg 46(1):e1–e7

    Article  PubMed  Google Scholar 

  14. Pasic M, Dreysse S, Unbehaun A, Buz S, Drews T, Klein C, D’Ancona G, Hetzer R (2012) Combined elective percutaneous coronary intervention and transapical transcatheter aortic valve implantation. Interact CardioVasc Thorac Surg 14(4):463–468

    Article  PubMed Central  PubMed  Google Scholar 

  15. Funkat AK, Beckmann A, Lewandowski J, Frie M, Schiller W, Ernst M, Hekmat K, Gummert JF, Mohr FW (2012) Cardiac surgery in Germany during 2011: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 60(6):371–382

    Article  PubMed  Google Scholar 

  16. Abdel-Wahab M, Mostafa AE, Richardt G (2012) A case of rotational atherectomy after implantation of the Medtronic CoreValve bioprosthesis. Clin Res Cardiol 101(7):595–597

    Article  PubMed  Google Scholar 

  17. Geist V, Sherif MA, Khattab AA (2009) Successful percutaneous coronary intervention after implantation of a CoreValve percutaneous aortic valve. Catheter Cardiovasc Interv 73(1):61–67

    Article  PubMed  Google Scholar 

  18. Blumenstein JM, Van Linden A, Moellmann H, Seeburger J, Rastan A, Kim WK, Mohr FW, Kempfert J, Walther T (2013) DynaCT-guided anatomical rotation of the SAPIEN XT valve during transapical aortic valve implantation: proof of concept. Thorac Cardiovasc Surg 61(5):409–413

    PubMed  Google Scholar 

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Conflict of interest

All authors agree with and take responsibility for this paper. There are no personal conflicts of interest with respect to this publication.

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Authors and Affiliations

  1. Department of Cardiology, Kerckhoff-Klinik Heart Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany

    Johannes Blumenstein, Won-Keun Kim, Christoph Liebetrau, Luise Gaede, Christian Hamm & Helge Möllmann

  2. Department of Cardiac Surgery, Kerckhoff-Klinik Heart Center, Bad Nauheim, Germany

    Won-Keun Kim, Joerg Kempfert & Thomas Walther

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  1. Johannes Blumenstein
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  2. Won-Keun Kim
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  3. Christoph Liebetrau
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  4. Luise Gaede
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  5. Joerg Kempfert
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  6. Thomas Walther
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  7. Christian Hamm
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  8. Helge Möllmann
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Correspondence to Johannes Blumenstein.

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Blumenstein, J., Kim, WK., Liebetrau, C. et al. Challenges of coronary angiography and intervention in patients previously treated by TAVI. Clin Res Cardiol 104, 632–639 (2015). https://doi.org/10.1007/s00392-015-0824-5

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  • DOI: https://doi.org/10.1007/s00392-015-0824-5

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