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Observational Study
. 2025 Jun 23;18(12):1571-1583.
doi: 10.1016/j.jcin.2025.05.002.

The Coronary Access After TAVI (CAvEAT) Study: A Prospective Registry of CA After TAVR

Giuseppe Tarantini  1 , Luca Nai Fovino  2 , Flavia Belloni  3 , Marco Barbierato  4 , Francesco Gallo  4 , Matteo Vercellino  5 , Carlo Trani  6 , Francesco Burzotta  6 , Lluis Asmarats Serra  7 , Anna Sonia Petronio  8 , Francesco Bedogni  9 , Sergio Berti  10 , Andrea Bertolini  2 , Tommaso Fabris  2 , Antonio Tito  11 , Carmine Musto  12 , Arturo Giordano  13 , Nicola Corcione  13 , Francesco Maisano  14 , Massimo Medda  15 , Bruno Loi  16 , Carlo Cernetti  17 , Luca Favero  17 , Emilio Di Lorenzo  18 , Dario Gregori  19 , Giulia Lorenzoni  19 , Mateusz Orzalkiewicz  20 , Giovanni Esposito  21 , Francesco Saia  20 , Francesco Cardaioli  2 , Alfredo Marchese  11 ; CAvEAT Investigators and the Italian Society of Interventional Cardiology
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Free article
Observational Study

The Coronary Access After TAVI (CAvEAT) Study: A Prospective Registry of CA After TAVR

Giuseppe Tarantini et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: As transcatheter aortic valve replacement (TAVR) is now performed in patients with longer life expectancy, the need for coronary access (CA) after TAVR is expected to rise.

Objectives: The aim of this study was to evaluate the feasibility of CA after TAVR with 4 different types of transcatheter heart valves (THVs).

Methods: In the multicenter, prospective CAvEAT (Coronary Access After TAVI; NCT04647864) registry, coronary angiography was performed immediately following transfemoral TAVR using short-frame SAPIEN 3 or SAPIEN 3 Ultra (SAPIEN 3/Ultra) and tall-frame ACURATE neo or ACURATE neo2 (ACURATE neo/neo2), Portico or Navitor, and Evolut Pro or Evolut Pro+ (Evolut Pro/Pro+) THVs. The primary endpoint was defined as selective CA of both coronary arteries.

Results: In total, 632 patients were enrolled (mean age 82 years, 59% women). Selective CA of both coronary arteries was achieved in 89% of SAPIEN 3/Ultra, 63% of ACURATE neo/neo2, 62% of Portico or Navitor, and 45% of Evolut Pro/Pro+ THVs (P < 0.001). Unfeasible CA of at least 1 coronary artery occurred in 2%, 6%, 6%, and 9% of cases, respectively (P = 0.06). In pairwise comparisons, the incidence of the primary endpoint was significantly higher for the SAPIEN 3/Ultra compared with all tall-frame THVs (P < 0.001). Among tall-frame devices, no significant difference was observed between the ACURATE neo/neo2 and the Portico or Navitor (P = 0.9), but both devices demonstrated higher rates of the primary endpoint than the Evolut Pro/Pro+ (P = 0.005 and P = 0.002, respectively). Multivariate analysis identified implantation depth, moderate or severe commissural misalignment, and use of a tall-frame THV as independent predictors of unfeasible or nonselective CA.

Conclusions: The short-frame SAPIEN 3/Ultra THV demonstrated the highest rate of selective CA following TAVR. Among tall-frame THVs, the large-cell designs of the Portico or Navitor and ACURATE neo/neo2 outperformed the closed-cell Evolut Pro/Pro+ in terms of selective CA.

Keywords: aortic stenosis; coronary access; coronary artery disease; transcatheter aortic valve replacement.

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Conflict of interest statement

Funding Support and Author Disclosures This study was sponsored by the Italian Society of Interventional Cardiology. Dr Tarantini has received honoraria for lectures and consulting from Abbott Laboratories, Boston Scientific, Edwards Lifesciences, Medtronic, and GADA. Dr Burzotta has received speaker fees from Abiomed, Abbott Laboratories, Medtronic, and Terumo. Dr Serra is a proctor for Abbott Laboratories. Dr Berti is a proctor for Boston Scientific and Edwards Lifesciences. Dr Maisano has received grants and/or institutional research support from Abbott Laboratories, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific, NVT, Terumo, Venus, and Roche; has received consulting fees and personal and institutional honoraria from Abbott Laboratories, Boston Scientific, Medtronic, Edwards Lifesciences, Xeltis, Cardiovalve, Occlufit, Simulands, Mtex, Venus, Squadra, Valgen, and CroiValve; has received royalty income from and holds intellectual property rights with Edwards Lifesciences; and is shareholder (including share options) of Magenta, Transseptal Solutions, and 4Tech. Dr Fovino has received consulting fees from Edwards Lifesciences; and has received institutional research grant from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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