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Abstract

Aim

We evaluate, performing a pooled meta-analysis, the current coronary artery accessibility rate in transcatheter aortic valve implantation (TAVI) patients during the follow-up. Full coronary artery accessibility after TAVI has not been adequately addressed by the current literature.

Methods

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, data on coronary artery access were obtained from the ratio between in the full coronary engagement (n) and the number of coronary angiography and/or percutaneous coronary intervention (N). Data were synthesized using random-effects meta-analyses.

Results

Out of 7048 TAVI patients, 276 (3.9%) (mean age 76.8 years, 111 (40.2%) females) were analysed. Full coronary artery accessibility for coronary angiographies and percutaneous coronary interventions were obtained in 83.0% (95% confidence interval (CI): 0.66–0.92, p = 0.001, I²: 88.2%) and 96.0% (95% CI: 0.90–0.98, p < 0.0001, I²: 0) of cases (p for difference < .0.001). Left coronary artery (n = 219) was easily fully engaged compared to the right one (90.9% (95% CI: 0.80–0.96, p < 0.0001, I²: 58.4% and 82.0% (95% CI: 0.60–0.93, p = 0.006, I²: 83.2%), respectively, (p for difference < 0.001). Using age as moderator variable, meta-regression revealed a positive and negative correlation with coronary artery accessibility in patients treated with Sapien-Edwards (p = 0.008) and CoreValve (p = 0.010) platforms, respectively. Conversely, a negative correlation (p = 0.01) was found between coronary artery accessibility and mean time after Sapien-Edwards platform implantation (p = 0.01).

Conclusions

Full coronary artery accessibility during coronary angiographies and/or percutaneous coronary interventions results suboptimal for both coronary artery ostia and worse for right compared to left coronary artery after TAVI.

Keywords

Transcatheter aortic valve implantation coronary artery disease percutaneous coronary intervention angiography

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Real world coronary artery ostia full accessibility after last generation transcatheter aortic valve implantation