title: Coronary Procedures After TAVI With the Self-Expanding Aortic Bioprosthesis Medtronic CoreValve™, Not an Easy Matter.
abstract: OBJECTIVE
  To evaluate the feasibility of coronary procedures after transcatheter aortic valve implantation (TAVI) with the CoreValve™ device.
  
  
  BACKGROUND
  Due to its design, CoreValve™ prosthesis may interfere with coronary procedures. Data on this issue are sparse.
  
  
  METHODS
  Between 2007 and 2015, 550 patients underwent CoreValve™ TAVI in our hospital. Among them, 16 underwent coronary angiogram after TAVI and were included in our retrospective study. For each patient, we compared the characteristics of coronary angiograms performed before and after TAVI.
  
  
  RESULTS
  Coronary angiogram was deemed successful in 9 patients. The mean number of different catheters used in attempts to cannulate the coronary arteries was 3.6 ± 1.4 and the rate of selective intubation was low. Fluoroscopy time (13.2 ± 5.8 vs. 7.2 ± 4.6 min, P = 0.003), dose area product (5,347 ± 4,919 vs. 3,433 ± 3,420 cGy/m2, P = 0.004), and contrast volume (157.7 ± 69.6 vs. 108.3 ± 42.6 mL, P = 0.006) were more important in coronary angiograms performed after CoreValve™ implantation. Percutaneous coronary intervention was successfully performed in 6 out of 7 patients who required it.
  
  
  CONCLUSIONS
  Coronary procedures after CoreValve™ TAVI are feasible, but challenging. This problem is currently rare but will be more common as the indications of TAVI are expanded to younger patients with longer life expectancies. Recommendations for post-TAVI coronary procedures are needed, particularly for centers unfamiliar with the management of post-TAVI patients.
authors.affiliation: Department of Cardiovascular, Henri Mondor University Hospital, Creteil, France.
authors.forename: Madjid
authors.initials: M
authors.lastname: Boukantar
authors.affiliation: Department of Cardiovascular, Henri Mondor University Hospital, Creteil, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Gallet
authors.affiliation: Department of Cardiovascular, Henri Mondor University Hospital, Creteil, France.
authors.forename: Gauthier
authors.initials: G
authors.lastname: Mouillet
authors.affiliation: Department of Cardiovascular, Henri Mondor University Hospital, Creteil, France.
authors.forename: Abdelkaoui
authors.initials: A
authors.lastname: Belarbi
authors.affiliation: Department of Cardiovascular, Henri Mondor University Hospital, Creteil, France.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Rubimbura
authors.affiliation: Department of Cardiovascular, Henri Mondor University Hospital, Creteil, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Ternacle
authors.affiliation: Department of Cardiovascular, Henri Mondor University Hospital, Creteil, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois-Rande
authors.affiliation: Department of Cardiovascular, Henri Mondor University Hospital, Creteil, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D011474:Prosthesis Design; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation*; D016896:Treatment Outcome