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. 2020 Nov 9;13(21):2542-2555.
doi: 10.1016/j.jcin.2020.07.006. Epub 2020 Oct 14.

Coronary Cannulation After Transcatheter Aortic Valve Replacement: The RE-ACCESS Study

Marco Barbanti  1 , Giuliano Costa  2 , Andrea Picci  2 , Enrico Criscione  2 , Claudia Reddavid  2 , Roberto Valvo  2 , Denise Todaro  2 , Wanda Deste  2 , Antonio Condorelli  2 , Matteo Scalia  2 , Alessandra Licciardello  2 , Giorgia Politi  2 , Giuseppe De Luca  2 , Orazio Strazzieri  2 , Silvia Motta  2 , Valeria Garretto  3 , Pierfrancesco Veroux  4 , Alessia Giaquinta  4 , Angelo Giuffrida  5 , Carmelo Sgroi  2 , Martin B Leon  6 , John G Webb  7 , Corrado Tamburino  2
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Free article

Coronary Cannulation After Transcatheter Aortic Valve Replacement: The RE-ACCESS Study

Marco Barbanti et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: The aims of this study were to investigate the feasibility of coronary ostia cannulation after transcatheter aortic valve replacement (TAVR) and to assess potential predictors of coronary access impairment.

Background: Certain data concerning the feasibility and reproducibility of coronary cannulation after TAVR are lacking.

Methods: RE-ACCESS (Reobtain Coronary Ostia Cannulation Beyond Transcatheter Aortic Valve Stent) was an investigator-driven, single-center, prospective, registry-based study that enrolled consecutive patients undergoing TAVR using all commercially available devices. All patients underwent coronary angiography before and after TAVR. The primary endpoint was the rate of unsuccessful coronary ostia cannulation after TAVR. Secondary endpoints were the identification of factors associated with the inability to selectively cannulate coronary ostia after TAVR.

Results: Among 300 patients enrolled in the RE-ACCESS study from December 2018 to January 2020, a total of 23 cases (7.7%) of unsuccessful coronary cannulation after TAVR were documented. This issue occurred in 22 of 23 cases with the use of Evolut R/PRO transcatheter aortic valves (TAVs) (17.9% vs. 0.4%; p < 0.01). In multivariate analysis, the use of Evolut R/PRO TAVs (odds ratio [OR]: 29.6; 95% confidence interval [CI]: 2.6 to 335.0; p < 0.01), the TAV-sinus of Valsalva relation (OR: 1.1 per 1-mm increase; 95% CI: 1.0 to 1.2; p < 0.01), and the mean TAV implantation depth (OR: 1.7 per 1-mm decrease; 95% CI: 1.3 to 2.3; p < 0.01) were found to be independent predictors of unsuccessful coronary cannulation after TAVR. A model combining these factors was demonstrated to predict with very high accuracy the risk for unsuccessful coronary cannulation after TAVR (area under the curve: 0.94; p < 0.01).

Conclusions: Unsuccessful coronary cannulation following TAVR was observed in 7.7% of patients and occurred almost exclusively in those receiving Evolut TAVs. The combination of Evolut TAV, a higher TAV-sinus of Valsalva relation, and implantation depth predicts with high accuracy the risk for unsuccessful coronary cannulation after TAVR. (Reobtain Coronary Ostia Cannulation Beyond Transcatheter Aortic Valve Stent [RE-ACCESS]; NCT04026204).

Keywords: TAVR; aortic stenosis; cannulation; coronary arteries; coronary artery disease.

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Conflict of interest statement

Author Relationship With Industry Dr. Barbanti is a consultant for Edwards Lifesciences; and is an advisory board member for Biotronik. Dr. Tamburino has received speaking honoraria from Medtronic, Abbott Vascular, Edwards Lifesciences, and Boston Scientific. Dr. Webb is a consultant to and has received research funding from Edwards Lifesciences, Abbott Vascular, Boston Scientific, and ViVitro Labs. Dr. Leon has received research grants from Boston Scientific, Edwards Lifesciences, and Medtronic; and is an unpaid member on the scientific advisory boards of Boston Scientific, Edwards Lifesciences, Gore, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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