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Coronary Catheterization and Percutaneous Interventions After Transcatheter Aortic Valve Implantation

Coronary artery disease (CAD) is often present in patients with severe aortic valve stenosis candidates to transcatheter aortic valve implantation (TAVI). Mild CAD may also worsen and need treatment years after TAVI. The implantation of a transcatheter valve may interfere with the capability of reen... Full description

Journal Title: The American journal of cardiology 2016, Vol.120 (4), p.625-631
Main Author: Zivelonghi, Carlo, MD
Other Authors: Pesarini, Gabriele, MD , Scarsini, Roberto, MD , Lunardi, Mattia, MD , Piccoli, Anna, MD , Ferrero, Valeria, MD , Gottin, Leonardo, MD , Vassanelli, Corrado, MD , Ribichini, Flavio, MD
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: United States: Elsevier Inc
ID: ISSN: 0002-9149
Link: https://www.ncbi.nlm.nih.gov/pubmed/27964903
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title: Coronary Catheterization and Percutaneous Interventions After Transcatheter Aortic Valve Implantation
format: Article
creator:
  • Zivelonghi, Carlo, MD
  • Pesarini, Gabriele, MD
  • Scarsini, Roberto, MD
  • Lunardi, Mattia, MD
  • Piccoli, Anna, MD
  • Ferrero, Valeria, MD
  • Gottin, Leonardo, MD
  • Vassanelli, Corrado, MD
  • Ribichini, Flavio, MD
subjects:
  • Abridged Index Medicus
  • Adenosine
  • Aged, 80 and over
  • Angiography
  • Angioplasty
  • Aorta
  • Aortic valve
  • Aortic Valve - surgery
  • Aortic valve stenosis
  • Aortic Valve Stenosis - complications
  • Aortic Valve Stenosis - diagnosis
  • Aortic Valve Stenosis - surgery
  • Arteries
  • Blood vessels
  • Cardiac Catheterization - methods
  • Cardiac patients
  • Cardiology
  • Cardiovascular
  • Cardiovascular disease
  • Catheterization
  • Catheters
  • Computed tomography
  • Coronary Angiography
  • Coronary artery
  • Coronary artery disease
  • Coronary Artery Disease - complications
  • Coronary Artery Disease - diagnosis
  • Coronary Artery Disease - surgery
  • Coronary heart disease
  • Coronary vessels
  • Coronary Vessels - diagnostic imaging
  • Coronary Vessels - surgery
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Heart
  • Heart diseases
  • Heart Valve Prosthesis
  • Heart valves
  • Humans
  • Implantation
  • Intervention
  • Male
  • Medical colleges
  • Medical imaging
  • Patients
  • Percutaneous Coronary Intervention
  • Prospective Studies
  • Prostheses
  • Reoperation
  • Rheumatic heart disease
  • Risk Factors
  • Stenosis
  • Transcatheter Aortic Valve Replacement
  • Transluminal angioplasty
  • Treatment Outcome
  • Usage
ispartof: The American journal of cardiology, 2016, Vol.120 (4), p.625-631
description: Coronary artery disease (CAD) is often present in patients with severe aortic valve stenosis candidates to transcatheter aortic valve implantation (TAVI). Mild CAD may also worsen and need treatment years after TAVI. The implantation of a transcatheter valve may interfere with the capability of reengaging the coronary arteries. We prospectively assessed the feasibility of performing coronary angiography (CA), fractional flow reserve, and, where indicated, percutaneous coronary intervention after valve implantation in a consecutive series of patients with CAD undergoing TAVI. Valve type and size were decided according to accurate computed tomography scan and angiographic measurement of the aortic root structures. We analyzed 66 consecutive patients undergoing TAVI, 41 with balloon-expandable, and 25 with self-expandable transcatheter valves. Right and left coronary catheterization (132 vessels) was successful in all cases except in 1 left coronary artery after a high implantation of a self-expandable valve (unsuccess rate, 1 in 50 vessels). In 6 of 132 vessels (4%), CA was initially nonselective, but after positioning the 0.014″ intracoronary guidewire, selective injections were obtained in all these cases. Percutaneous coronary intervention was performed successfully in 19 coronary vessels (17 patients) as indicated by fractional flow reserve measurements. In conclusion, catheterization of the coronary ostia after transfemoral TAVI with balloon or self-expandable valves is safe and feasible in almost all cases. Accurate imaging of the aortic root and procedural planning may help to avoid too high implantation of supra-annular self-expandable valves to obviate difficulties in accessing coronary ostia. Use of intracoronary guidewires facilitates selective CA in cases with difficult access.
language: eng
source:
identifier: ISSN: 0002-9149
fulltext: no_fulltext
issn:
  • 0002-9149
  • 1879-1913
url: Link


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titleCoronary Catheterization and Percutaneous Interventions After Transcatheter Aortic Valve Implantation
creatorZivelonghi, Carlo, MD ; Pesarini, Gabriele, MD ; Scarsini, Roberto, MD ; Lunardi, Mattia, MD ; Piccoli, Anna, MD ; Ferrero, Valeria, MD ; Gottin, Leonardo, MD ; Vassanelli, Corrado, MD ; Ribichini, Flavio, MD
creatorcontribZivelonghi, Carlo, MD ; Pesarini, Gabriele, MD ; Scarsini, Roberto, MD ; Lunardi, Mattia, MD ; Piccoli, Anna, MD ; Ferrero, Valeria, MD ; Gottin, Leonardo, MD ; Vassanelli, Corrado, MD ; Ribichini, Flavio, MD
descriptionCoronary artery disease (CAD) is often present in patients with severe aortic valve stenosis candidates to transcatheter aortic valve implantation (TAVI). Mild CAD may also worsen and need treatment years after TAVI. The implantation of a transcatheter valve may interfere with the capability of reengaging the coronary arteries. We prospectively assessed the feasibility of performing coronary angiography (CA), fractional flow reserve, and, where indicated, percutaneous coronary intervention after valve implantation in a consecutive series of patients with CAD undergoing TAVI. Valve type and size were decided according to accurate computed tomography scan and angiographic measurement of the aortic root structures. We analyzed 66 consecutive patients undergoing TAVI, 41 with balloon-expandable, and 25 with self-expandable transcatheter valves. Right and left coronary catheterization (132 vessels) was successful in all cases except in 1 left coronary artery after a high implantation of a self-expandable valve (unsuccess rate, 1 in 50 vessels). In 6 of 132 vessels (4%), CA was initially nonselective, but after positioning the 0.014″ intracoronary guidewire, selective injections were obtained in all these cases. Percutaneous coronary intervention was performed successfully in 19 coronary vessels (17 patients) as indicated by fractional flow reserve measurements. In conclusion, catheterization of the coronary ostia after transfemoral TAVI with balloon or self-expandable valves is safe and feasible in almost all cases. Accurate imaging of the aortic root and procedural planning may help to avoid too high implantation of supra-annular self-expandable valves to obviate difficulties in accessing coronary ostia. Use of intracoronary guidewires facilitates selective CA in cases with difficult access.
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languageeng
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subjectAbridged Index Medicus ; Adenosine ; Aged, 80 and over ; Angiography ; Angioplasty ; Aorta ; Aortic valve ; Aortic Valve - surgery ; Aortic valve stenosis ; Aortic Valve Stenosis - complications ; Aortic Valve Stenosis - diagnosis ; Aortic Valve Stenosis - surgery ; Arteries ; Blood vessels ; Cardiac Catheterization - methods ; Cardiac patients ; Cardiology ; Cardiovascular ; Cardiovascular disease ; Catheterization ; Catheters ; Computed tomography ; Coronary Angiography ; Coronary artery ; Coronary artery disease ; Coronary Artery Disease - complications ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - surgery ; Coronary heart disease ; Coronary vessels ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - surgery ; Feasibility Studies ; Female ; Follow-Up Studies ; Heart ; Heart diseases ; Heart Valve Prosthesis ; Heart valves ; Humans ; Implantation ; Intervention ; Male ; Medical colleges ; Medical imaging ; Patients ; Percutaneous Coronary Intervention ; Prospective Studies ; Prostheses ; Reoperation ; Rheumatic heart disease ; Risk Factors ; Stenosis ; Transcatheter Aortic Valve Replacement ; Transluminal angioplasty ; Treatment Outcome ; Usage
ispartofThe American journal of cardiology, 2016, Vol.120 (4), p.625-631
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5Ferrero, Valeria, MD
6Gottin, Leonardo, MD
7Vassanelli, Corrado, MD
8Ribichini, Flavio, MD
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descriptionCoronary artery disease (CAD) is often present in patients with severe aortic valve stenosis candidates to transcatheter aortic valve implantation (TAVI). Mild CAD may also worsen and need treatment years after TAVI. The implantation of a transcatheter valve may interfere with the capability of reengaging the coronary arteries. We prospectively assessed the feasibility of performing coronary angiography (CA), fractional flow reserve, and, where indicated, percutaneous coronary intervention after valve implantation in a consecutive series of patients with CAD undergoing TAVI. Valve type and size were decided according to accurate computed tomography scan and angiographic measurement of the aortic root structures. We analyzed 66 consecutive patients undergoing TAVI, 41 with balloon-expandable, and 25 with self-expandable transcatheter valves. Right and left coronary catheterization (132 vessels) was successful in all cases except in 1 left coronary artery after a high implantation of a self-expandable valve (unsuccess rate, 1 in 50 vessels). In 6 of 132 vessels (4%), CA was initially nonselective, but after positioning the 0.014″ intracoronary guidewire, selective injections were obtained in all these cases. Percutaneous coronary intervention was performed successfully in 19 coronary vessels (17 patients) as indicated by fractional flow reserve measurements. In conclusion, catheterization of the coronary ostia after transfemoral TAVI with balloon or self-expandable valves is safe and feasible in almost all cases. Accurate imaging of the aortic root and procedural planning may help to avoid too high implantation of supra-annular self-expandable valves to obviate difficulties in accessing coronary ostia. Use of intracoronary guidewires facilitates selective CA in cases with difficult access.
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1Adenosine
2Aged, 80 and over
3Angiography
4Angioplasty
5Aorta
6Aortic valve
7Aortic Valve - surgery
8Aortic valve stenosis
9Aortic Valve Stenosis - complications
10Aortic Valve Stenosis - diagnosis
11Aortic Valve Stenosis - surgery
12Arteries
13Blood vessels
14Cardiac Catheterization - methods
15Cardiac patients
16Cardiology
17Cardiovascular
18Cardiovascular disease
19Catheterization
20Catheters
21Computed tomography
22Coronary Angiography
23Coronary artery
24Coronary artery disease
25Coronary Artery Disease - complications
26Coronary Artery Disease - diagnosis
27Coronary Artery Disease - surgery
28Coronary heart disease
29Coronary vessels
30Coronary Vessels - diagnostic imaging
31Coronary Vessels - surgery
32Feasibility Studies
33Female
34Follow-Up Studies
35Heart
36Heart diseases
37Heart Valve Prosthesis
38Heart valves
39Humans
40Implantation
41Intervention
42Male
43Medical colleges
44Medical imaging
45Patients
46Percutaneous Coronary Intervention
47Prospective Studies
48Prostheses
49Reoperation
50Rheumatic heart disease
51Risk Factors
52Stenosis
53Transcatheter Aortic Valve Replacement
54Transluminal angioplasty
55Treatment Outcome
56Usage
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titleCoronary Catheterization and Percutaneous Interventions After Transcatheter Aortic Valve Implantation
authorZivelonghi, Carlo, MD ; Pesarini, Gabriele, MD ; Scarsini, Roberto, MD ; Lunardi, Mattia, MD ; Piccoli, Anna, MD ; Ferrero, Valeria, MD ; Gottin, Leonardo, MD ; Vassanelli, Corrado, MD ; Ribichini, Flavio, MD
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0Abridged Index Medicus
1Adenosine
2Aged, 80 and over
3Angiography
4Angioplasty
5Aorta
6Aortic valve
7Aortic Valve - surgery
8Aortic valve stenosis
9Aortic Valve Stenosis - complications
10Aortic Valve Stenosis - diagnosis
11Aortic Valve Stenosis - surgery
12Arteries
13Blood vessels
14Cardiac Catheterization - methods
15Cardiac patients
16Cardiology
17Cardiovascular
18Cardiovascular disease
19Catheterization
20Catheters
21Computed tomography
22Coronary Angiography
23Coronary artery
24Coronary artery disease
25Coronary Artery Disease - complications
26Coronary Artery Disease - diagnosis
27Coronary Artery Disease - surgery
28Coronary heart disease
29Coronary vessels
30Coronary Vessels - diagnostic imaging
31Coronary Vessels - surgery
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35Heart
36Heart diseases
37Heart Valve Prosthesis
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52Stenosis
53Transcatheter Aortic Valve Replacement
54Transluminal angioplasty
55Treatment Outcome
56Usage
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6Gottin, Leonardo, MD
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issn0002-9149
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abstractCoronary artery disease (CAD) is often present in patients with severe aortic valve stenosis candidates to transcatheter aortic valve implantation (TAVI). Mild CAD may also worsen and need treatment years after TAVI. The implantation of a transcatheter valve may interfere with the capability of reengaging the coronary arteries. We prospectively assessed the feasibility of performing coronary angiography (CA), fractional flow reserve, and, where indicated, percutaneous coronary intervention after valve implantation in a consecutive series of patients with CAD undergoing TAVI. Valve type and size were decided according to accurate computed tomography scan and angiographic measurement of the aortic root structures. We analyzed 66 consecutive patients undergoing TAVI, 41 with balloon-expandable, and 25 with self-expandable transcatheter valves. Right and left coronary catheterization (132 vessels) was successful in all cases except in 1 left coronary artery after a high implantation of a self-expandable valve (unsuccess rate, 1 in 50 vessels). In 6 of 132 vessels (4%), CA was initially nonselective, but after positioning the 0.014″ intracoronary guidewire, selective injections were obtained in all these cases. Percutaneous coronary intervention was performed successfully in 19 coronary vessels (17 patients) as indicated by fractional flow reserve measurements. In conclusion, catheterization of the coronary ostia after transfemoral TAVI with balloon or self-expandable valves is safe and feasible in almost all cases. Accurate imaging of the aortic root and procedural planning may help to avoid too high implantation of supra-annular self-expandable valves to obviate difficulties in accessing coronary ostia. Use of intracoronary guidewires facilitates selective CA in cases with difficult access.
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