Case Presentation: Coronary Intervention Following TAVI with an Evolut Valve
Presenter
Huazhen Chen, Icahn School of Medicine at Mount Sinai Morningside, New York, NY
Huazhen Chen, Icahn School of Medicine at Mount Sinai Morningside, New York, NY
Keywords: Coronary, Drug-eluting Stent (DES) and TAVI/TAVR/Aortic Valve
Title
Percutaneous Coronary Intervention Following Transcatheter Aortic Valve Implantation with an Evolut Valve
Introduction
Percutaneous coronary intervention (PCI) following transcatheter aortic valve implantation (TAVI) has become increasingly more common due to its expanded indications to younger patients, who may develop obstructive coronary artery disease (CAD) later in their lives. This population will derive a significant benefit from coronary intervention following TAVI due to an expected longer lifespan. Coronary access following TAVI is affected by factors including the design of the transcatheter aortic valve (TAV), and the spatial relationship between the THV and the aortic root. This becomes especially challenging in supra-annular devices with taller frame design. As a result, there is a growing interest in optimizing the feasibility of coronary cannulation after TAVI.
Clinical Case
We present a 69-year-old female with a history of severe aortic stenosis s/p TAVI in 2023 (Evolut FX 26 mm), non-obstructive CAD, type 2 diabetes and hypertension who presented with unstable angina. She was found to have a heavily calcified, severely stenotic mLAD lesion. In the presence of the Evolut valve, femoral access was obtained for the PCI. We used a shorter guide catheter than usual, which resulted in perpendicular crossing of the frame cell and coaxial coronary engagement. We then performed rotational atherectomy assisted PCI of mLAD with drug eluting stent x 1, which achieved an excellent result.
Discussion
Performing PCI in patients with TAV will become increasingly more common due to the expansion of TAVI to a younger population. Key issues to consider in order to optimize coronary intervention include the appreciation of THV design, the spatial relationship between THV and the aortic root and careful selection and manipulation of guide catheter.