title: Incidence, feasibility and outcome of percutaneous coronary intervention after transcatheter aortic valve implantation with a self-expanding prosthesis. Results from a single center experience.
abstract: OBJECTIVE
  Percutaneous coronary intervention (PCI) after transcatheter aortic valve implantation (TAVI) can become technically challenging after implantation of the self-expanding Medtronic CoreValve (MCV) device, which completely covers the aortic root. The aim of this study was to report on the incidence, feasibility and outcome of PCI after TAVI with the MCV device.
  
  
  METHODS
  Between 2007 and 2014, all patients subjected to PCI after MCV implantation in a single-center institutional TAVI database were retrospectively identified. Clinical, angiographic and procedural characteristics were reviewed and analyzed.
  
  
  RESULTS
  We identified a total of 17 patients (5.7%) treated with 24 PCI procedures for 29 lesions at a median of 17.7months (range 1-72) after MCV implantation. The mean age was 79.7±6.8years and the mean logistic EuroSCORE was 30.3%±18.9%. Nine procedures were performed for patients with acute coronary syndrome. 89.6% of the treated lesions were of type B2/C and 79.3% were de novo ones. A median of one guiding catheter was necessary to intubate the target coronary ostium (range 1-10) and 95% of the lesions on the left coronary artery were treated through a Judkins catheter. In one primary PCI for STEMI the intubation of the right coronary ostium was not successful. Final procedural success was obtained in 95.8%, and peri-procedural death occurred in one patient.
  
  
  CONCLUSIONS
  The need for PCI after MCV is not uncommon and is mostly related to coronary artery disease progression. PCI after MCV is usually feasible and safe, but coronary intubation in an emergency setting can be challenging.
authors.affiliation: Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany.
authors.forename: Abdelhakim
authors.initials: A
authors.lastname: Allali
authors.affiliation: Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany.
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Mawardy
authors.affiliation: Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Schwarz
authors.affiliation: Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany.
authors.forename: Takao
authors.initials: T
authors.lastname: Sato
authors.affiliation: Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Geist
authors.affiliation: Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Toelg
authors.affiliation: Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany.
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.affiliation: Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany. Electronic address: mohamed.abdel-wahab@segebergerkliniken.de.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Wahab
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
keywords: Aortic stenosis; Percutaneous coronary intervention; Self-expanding CoreValve