Valvular & structural heart disease

Coronary Cannulation Following Transcatheter Aortic Valve Replacement (TAVR) Using Self-Expanding Devices With Commissural Alignment: The RE-ACCESS 2 Study

JACC Cardiovasc IntervPublished Prospective cohort study

Authors' conclusion

Unsuccessful coronary cannulation after TAVR using self-expanding THVs implanted using CA techniques was reported in 5.5% of cases, with the majority involving the Evolut THV. Commissural misalignment affected coronary cannulation after TAVR mostly in Evolut recipients.

Study context

Population
Consecutive TAVR patients receiving self-expanding transcatheter heart valves (THVs) implanted using commissural alignment, single centre, September 2021–December 2022
Participants
127 patients
Exposure
Evolut vs ACURATE self-expanding THVs implanted with commissural alignment
Outcome
Unsuccessful coronary cannulation after TAVR
Methodological detailssingle-centre, investigator-driven, consecutive patients
  • Single-centre
  • Investigator-driven
  • Consecutive patients

Main finding

As reported in the abstract

P = 0.26

Overall unsuccessful coronary cannulation
7 (5.5%)

Observational data: associations, not effects.

Secondary outcomes

Failure of left coronary artery cannulation

P = 1.00

Failure of right coronary artery cannulation

P = 0.16

Predictors of unfeasible selective coronary re-engagement on post-TAVR CT angiography

OR (95% CI)P value
Coronary overlap5.6 (1.2–25.8)P = 0.03
Severe misalignment of Evolut THVsInability to selectively cannulate both coronary arteries24.7 (1.9–312.9)P = 0.01
  • Predictors of unfeasible selective coronary re-engagement on post-TAVR CT angiography: inability to selectively cannulate the right coronary artery; not in ACURATE recipients (P = 0.39)

Original publication

Coronary Cannulation Following TAVR Using Self-Expanding Devices With Commissural Alignment: The RE-ACCESS 2 Study. JACC Cardiovasc Interv. Published 6 March 2024. doi:10.1016/j.jcin.2023.12.015

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