Coronary Angiography and Percutaneous Coronary Intervention After Transcatheter Aortic Valve Replacement

J Am Coll Cardiol. 2018 Mar 27;71(12):1360-1378. doi: 10.1016/j.jacc.2018.01.057.


Transcatheter aortic valve replacement (TAVR) has revolutionized the management of patients with symptomatic severe aortic stenosis, and indications are expanding towards treating younger patients with lower-risk profiles. Given the progressive nature of coronary artery disease and its high prevalence in those with severe aortic stenosis, coronary angiography and percutaneous coronary intervention will become increasingly necessary in patients after TAVR. There are some data suggesting that there are technical difficulties with coronary re-engagement, particularly in patients with self-expanding valves that, by design, extend above the coronary ostia. The authors review the challenges of coronary angiography and percutaneous coronary intervention post-TAVR and examine the geometric interactions between currently approved transcatheter aortic valves and coronary ostia, while providing a practical guide on how to manage these potentially complex situations.

Keywords: aortic stenosis; aortic valve; cardiac catheterization; coronary artery disease.

Publication types

  • Review

MeSH terms

  • Aortic Valve Stenosis / diagnostic imaging*
  • Aortic Valve Stenosis / surgery*
  • Clinical Trials as Topic / methods
  • Coronary Angiography / methods*
  • Coronary Angiography / trends
  • Humans
  • Percutaneous Coronary Intervention / methods*
  • Percutaneous Coronary Intervention / trends
  • Transcatheter Aortic Valve Replacement / methods*
  • Transcatheter Aortic Valve Replacement / trends
  • Treatment Outcome