The design of the Evolut frame, together with minor procedural adjustments and catheter selection based on the patient’s anatomy, helps facilitate post-TAVR coronary access. Highlights of this unique frame design include:
With a few essential considerations, you can access coronaries through the Evolut frame, optimize post-TAVR coronary access procedures, and approach these cases with confidence.
Insert pigtail within Evolut frame choose an orthogonal view of desired coronary, and perform an aortogram.
Exchange to catheter shape based on root size/shape and location of commissure; downsize by 0.5 cm.
Approach coronary coaxially, remain perpendicular to frame. Do not approach from below.¹ Use J-wire for aid.
Image courtesy of James Harvey, M.D.
Perform nonselective angio/use guidewire and guide extension devices to reach ostium and perform diagnostic/PCI.
Image courtesy of Harold Dauerman, M.D.
Always disengage catheter/guide over a guidewire.
The considerations for post-TAVR coronary access were created through a detailed review of available data, including publications and proctor input. These methods (including the use of accessory devices) have not been verified through bench testing.
For more detailed information, get our interactive procedural guidance document for post-TAVR coronary access.
Unplanned post-TAVR PCI is a rare but serious situation. Fortunately, data from a 15,325-patient multicenter international registry showed that successful treatment and outcomes are likely regardless of the TAVR device.
Gaining coronary access through any TAVR device can create complexities. But procedural considerations, commissural alignment, and effective case planning make the process feasible.
TAVR risks may include, but are not limited to, death, stroke, damage to the arteries, bleeding, and need for permanent pacemaker.
Understand the impact on final valve orientation and coronary artery overlap in a paper published in JACC by Dr. Tang, Dr. Zaid, and Dr. Fuchs, et al.
Dr. Harvey and Dr. Dauerman on procedural considerations for low-risk patients — including post-TAVR coronary access and commissural alignment.
Dr. Spies and Dr. Stinis share their perspectives on post-TAVR coronary access. They discuss the incidence of CAD, a literature review on PCI, and case reviews.
Harhash A, Ansari J, Mandel L, Kipperman R. STEMI After TAVR: Procedural Challenge and Catastrophic Outcome. JACC Cardiovasc Interv. July 11, 2016;9(13):1412–1413.
Stefanini GG, Cerrato E, Pivato CA, et al. Unplanned Percutaneous Coronary Revascularization After TAVR. JACC Cardiovasc Interv. January 25, 2021;14(2):198–207.