Won-Keun Kim1, Costanza Pellegrini2, Sebastian Ludwig3, Helge Möllmann4, Florian Leuschner5, Raj Makkar6, Jürgen Leick7, Ignacio J Amat-Santos8, Oliver Dörr9, Philipp Breitbart10, Victor A Jimenez Diaz11, Maciej Dabrowski12, Tanja Rudolph13, Pablo Avanzas14, Jatinderjit Kaur15, Stefan Toggweiler16, Sebastian Kerber17, Patrick Ranosch17, Damiano Regazzoli18, Derk Frank19, Uri Landes20, John Webb21, Marco Barbanti22, Paola Purita23, Thomas Pilgrim24, Branislav Liska25, Noriaki Tabata26, Tobias Rheude2, Moritz Seiffert3, Clemens Eckel4, Abdelhakim Allali15, Roberto Valvo22, Sung-Han Yoon6, Nikos Werner7, Holger Nef27, Yeong-Hoon Choi28, Christian W Hamm27, Jan-Malte Sinning26. 1. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany; Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany. Electronic address: w.kim@kerckhoff-klinik.de. 2. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany. 3. Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany. 4. Department of Cardiology, St. Johannes Hospital, Dortmund, Germany. 5. Department of Medicine III, University of Heidelberg, German Centre for Cardiovascular Research (DZHK), Heidelberg, Germany. 6. Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California, USA. 7. Department of Cardiology, Barmherzige Brüder Hospital, Trier, Germany. 8. CIBERCV, University Clinic Hospital of Valladolid, Valladolid, Spain. 9. Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany. 10. Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany. 11. Hospital Alvaro Cunqueiro, Interventional Cardiology Unit, Cardiology Department, University Hospital of Vigo, Vigo, Spain. 12. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. 13. Herz- und Diabeteszentrum NRW, Department of General and Interventional Cardiology and Angiology, Ruhr-University Bochum, Bad Oeynhausen, Germany. 14. Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Department of Medicine, University of Oviedo, Oviedo, Spain. 15. Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany. 16. Heart Center Lucerne, Lucerner Kantonsspital, Lucerne, Switzerland. 17. Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt an der Saale, Germany. 18. Humanitas Clinical and Research Center, IRCCS, Milan, Italy. 19. Department of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), UKSH University Clinical Center Schleswig-Holstein, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany. 20. Centre for Cardiovascular Innovation, Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel. 21. Centre for Cardiovascular Innovation, Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada. 22. Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco," Catania, Italy. 23. Interventional Cardiology, Department of Cardiacthoracic and Vascular Science, Ospedale dell'Angelo, Venice, Italy. 24. Department of Cardiology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland. 25. National Cardiovascular Institute, Bratislava, Slovak Republic. 26. University Hospital Bonn, Heart Center Bonn, Bonn, Germany. 27. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany; Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany. 28. Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.
Abstract
OBJECTIVES: The aim of this study was to characterize the feasibility of coronary angiography (CA) and percutaneous coronary intervention (PCI) in acute settings among patients who have undergone transcatheter aortic valve replacement (TAVR). BACKGROUND: Impaired coronary access after TAVR may be challenging and particularly in acute settings could have deleterious consequences. METHODS: In this international registry, data from patients with prior TAVR requiring urgent or emergent CA were retrospectively collected. A total of 449 patients from 25 sites with acute coronary syndromes (89.1%) and other acute cardiovascular situations (10.9%) were included. RESULTS: Success rates were high for CA of the right coronary artery (98.3%) and left coronary artery (99.3%) and were higher among patients with short stent-frame prostheses (SFPs) than in those with long SFPs for CA of the right coronary artery (99.6% vs 95.9%; P = 0.005) but not for CA of the left coronary artery (99.7% vs 98.7%; P = 0.24). PCI of native coronary arteries was successful in 91.4% of cases and independent of valve type (short SFP 90.4% vs long SFP 93.4%; P = 0.44). Guide engagement failed in 6 patients, of whom 3 underwent emergent coronary artery bypass grafting and another 3 died in the hospital. Among patients requiring revascularization of native vessels, independent predictors of 30-day all-cause mortality were prior diabetes, cardiogenic shock, and failed PCI but not valve type or success of coronary engagement. CONCLUSIONS: CA or PCI after TAVR in acute settings is usually successful, but selective coronary engagement may be more challenging in the presence of long SFPs. Among patients requiring PCI, prior diabetes, cardiogenic shock, and failed PCI were predictors of early mortality.
OBJECTIVES: The aim of this study was to characterize the feasibility of coronary angiography (CA) and percutaneous coronary intervention (PCI) in acute settings among patients who have undergone transcatheter aortic valve replacement (TAVR). BACKGROUND: Impaired coronary access after TAVR may be challenging and particularly in acute settings could have deleterious consequences. METHODS: In this international registry, data from patients with prior TAVR requiring urgent or emergent CA were retrospectively collected. A total of 449 patients from 25 sites with acute coronary syndromes (89.1%) and other acute cardiovascular situations (10.9%) were included. RESULTS: Success rates were high for CA of the right coronary artery (98.3%) and left coronary artery (99.3%) and were higher among patients with short stent-frame prostheses (SFPs) than in those with long SFPs for CA of the right coronary artery (99.6% vs 95.9%; P = 0.005) but not for CA of the left coronary artery (99.7% vs 98.7%; P = 0.24). PCI of native coronary arteries was successful in 91.4% of cases and independent of valve type (short SFP 90.4% vs long SFP 93.4%; P = 0.44). Guide engagement failed in 6 patients, of whom 3 underwent emergent coronary artery bypass grafting and another 3 died in the hospital. Among patients requiring revascularization of native vessels, independent predictors of 30-day all-cause mortality were prior diabetes, cardiogenic shock, and failed PCI but not valve type or success of coronary engagement. CONCLUSIONS: CA or PCI after TAVR in acute settings is usually successful, but selective coronary engagement may be more challenging in the presence of long SFPs. Among patients requiring PCI, prior diabetes, cardiogenic shock, and failed PCI were predictors of early mortality.
Authors: Helge Mollmann; Axel Linke; Luis Nombela-Franco; Martin Sluka; Juan Francisco Oteo Dominguez; Matteo Montorfano; Won-Keun Kim; Martin Arnold; Mariuca Vasa-Nicotera; Lenard Conradi; Anthony Camuglia; Francesco Bedogni; Ganesh Manoharan Journal: J Clin Med Date: 2022-08-18 Impact factor: 4.964
Authors: Arif A Khokhar; Francesco Ponticelli; Adriana Zlahoda-Huzior; Kailash Chandra; Rossella Ruggiero; Marco Toselli; Francesco Gallo; Alberto Cereda; Alessandro Sticchi; Alessandra Laricchia; Damiano Regazzoli; Antonio Mangieri; Bernhard Reimers; Simone Biscaglia; Carlo Tumscitz; Gianluca Campo; Ghada W Mikhail; Won-Keun Kim; Antonio Colombo; Dariusz Dudek; Francesco Giannini Journal: Front Cardiovasc Med Date: 2022-09-14