Cardiology Division of the University Hospital of Geneva, Switzerland.
Cardiol J. 2022;29(2):197-204. doi: 10.5603/CJ.a2020.0073. Epub 2020 May 21.
Performing selective coronary angiogram (CA) and percutaneous coronary intervention (PCI) post transcatheter aortic valve implantation (TAVI) may be challenging with various success rates of coronary ostia engagement.
Among all patients who underwent CA and/or PCI after TAVI from our single center TAVI registry, ostia cannulation success was reported according to the quality of ostia engagement and artery opacification, and was classified as either selective, partially selective or non-selective but sufficient for diagnosis.
Among the 424 consecutive TAVI procedures performed at the aforementioned institution, 20 (4.7%) CA were performed in 19 (4.5%) patients at a median time of 464 days post TAVI (25-75% IQ: 213-634 days). CA were performed in 7 CoreValve, 9 Evolut R, 1 Evolut PRO and 2 Edwards Sapien 3 devices. Transradial vascular approach was attempted in 9 procedures (45%, right n = 6 and left n = 3) and was successful in 8 (40%) patients. A total of 20 left main artery ostium cannulation were attempted leading to a diagnostic CA in all of them with selective engagement in 65%. Engagement of the right coronary artery in 2 out of 15 attempted cases failed due to a low ostium in conjunction with a high implantation of a CoreValve prosthesis. 11 PCI (55% of CA) including 2 left main lesions were performed. In 4 patients (36.4% of the PCI), an extension catheter was required to engage the left main. All planned PCI were successful.
Post TAVI CA and PCI are challenging but feasible even after supra-annular self-expandable valve implantation.
经导管主动脉瓣置换术（TAVI）后行选择性冠状动脉造影（CA）和经皮冠状动脉介入治疗（PCI）可能具有挑战性，因为冠状动脉口的吻合成功率各不相同。
在我们的单中心 TAVI 注册中心，所有 TAVI 后行 CA 和/或 PCI 的患者中，根据冠状动脉口吻合质量和动脉显影情况报告了冠状动脉口插管成功率，并分为选择性、部分选择性或非选择性但足以诊断。
在上述机构进行的 424 例连续 TAVI 手术中，19 例（4.5%）患者在 TAVI 后中位时间 464 天（25-75% IQ：213-634 天）内行 20 次 CA（4.7%）。CA 在 7 例 CoreValve、9 例 Evolut R、1 例 Evolut PRO 和 2 例 Edwards Sapien 3 装置中进行。9 例（45%，右 n = 6，左 n = 3）尝试经桡动脉血管入路，8 例（40%）成功。总共尝试了 20 次左主干动脉口插管，所有尝试均获得了诊断性 CA，选择性吻合率为 65%。在 15 例尝试中，有 2 例右冠状动脉未能吻合，原因是冠状动脉口较低，同时 CoreValve 假体植入较高。进行了 11 次 PCI（CA 的 55%），其中包括 2 例左主干病变。在 4 例患者（PCI 的 36.4%）中，需要使用扩张导管才能吻合左主干。所有计划的 PCI 均成功。
TAVI 后 CA 和 PCI 具有挑战性，但即使在瓣上自膨式瓣膜植入后也可行。
