TY - JOUR
T1 - The Coronary Access After TAVI (CAvEAT) Study: A Prospective Registry of CA After TAVR
AU - Tarantini, Giuseppe
AU - Nai Fovino, Luca
AU - Belloni, Flavia
AU - Barbierato, Marco
AU - Gallo, Francesco
AU - Vercellino, Matteo
AU - Trani, Carlo
AU - Burzotta, Francesco
AU - Asmarats Serra, Lluis
AU - Petronio, Anna Sonia
AU - Bedogni, Francesco
AU - Berti, Sergio
AU - Bertolini, Andrea
AU - Fabris, Tommaso
AU - Tito, Antonio
AU - Musto, Carmine
AU - Giordano, Arturo
AU - Corcione, Nicola
AU - Maisano, Francesco
AU - Medda, Massimo
AU - Loi, Bruno
AU - Cernetti, Carlo
AU - Favero, Luca
AU - Di Lorenzo, Emilio
AU - Gregori, Dario
AU - Lorenzoni, Giulia
AU - Orzalkiewicz, Mateusz
AU - Esposito, Giovanni
AU - Saia, Francesco
AU - Cardaioli, Francesco
AU - Marchese, Alfredo
PY - 2025
Y1 - 2025
N2 - Background: As transcatheter aortic valve replacement (TAVR) is now performed in patients with longer life expectancy, the need for coronary access (CA) after TAVR is expected to rise. Objectives: The aim of this study was to evaluate the feasibility of CA after TAVR with 4 different types of transcatheter heart valves (THVs). Methods: In the multicenter, prospective CAvEAT (Coronary Access After TAVI; NCT04647864) registry, coronary angiography was performed immediately following transfemoral TAVR using short-frame SAPIEN 3 or SAPIEN 3 Ultra (SAPIEN 3/Ultra) and tall-frame ACURATE neo or ACURATE neo2 (ACURATE neo/neo2), Portico or Navitor, and Evolut Pro or Evolut Pro+ (Evolut Pro/Pro+) THVs. The primary endpoint was defined as selective CA of both coronary arteries. Results: In total, 632 patients were enrolled (mean age 82 years, 59% women). Selective CA of both coronary arteries was achieved in 89% of SAPIEN 3/Ultra, 63% of ACURATE neo/neo2, 62% of Portico or Navitor, and 45% of Evolut Pro/Pro+ THVs (P < 0.001). Unfeasible CA of at least 1 coronary artery occurred in 2%, 6%, 6%, and 9% of cases, respectively (P = 0.06). In pairwise comparisons, the incidence of the primary endpoint was significantly higher for the SAPIEN 3/Ultra compared with all tall-frame THVs (P < 0.001). Among tall-frame devices, no significant difference was observed between the ACURATE neo/neo2 and the Portico or Navitor (P = 0.9), but both devices demonstrated higher rates of the primary endpoint than the Evolut Pro/Pro+ (P = 0.005 and P = 0.002, respectively). Multivariate analysis identified implantation depth, moderate or severe commissural misalignment, and use of a tall-frame THV as independent predictors of unfeasible or nonselective CA. Conclusions: The short-frame SAPIEN 3/Ultra THV demonstrated the highest rate of selective CA following TAVR. Among tall-frame THVs, the large-cell designs of the Portico or Navitor and ACURATE neo/neo2 outperformed the closed-cell Evolut Pro/Pro+ in terms of selective CA.
AB - Background: As transcatheter aortic valve replacement (TAVR) is now performed in patients with longer life expectancy, the need for coronary access (CA) after TAVR is expected to rise. Objectives: The aim of this study was to evaluate the feasibility of CA after TAVR with 4 different types of transcatheter heart valves (THVs). Methods: In the multicenter, prospective CAvEAT (Coronary Access After TAVI; NCT04647864) registry, coronary angiography was performed immediately following transfemoral TAVR using short-frame SAPIEN 3 or SAPIEN 3 Ultra (SAPIEN 3/Ultra) and tall-frame ACURATE neo or ACURATE neo2 (ACURATE neo/neo2), Portico or Navitor, and Evolut Pro or Evolut Pro+ (Evolut Pro/Pro+) THVs. The primary endpoint was defined as selective CA of both coronary arteries. Results: In total, 632 patients were enrolled (mean age 82 years, 59% women). Selective CA of both coronary arteries was achieved in 89% of SAPIEN 3/Ultra, 63% of ACURATE neo/neo2, 62% of Portico or Navitor, and 45% of Evolut Pro/Pro+ THVs (P < 0.001). Unfeasible CA of at least 1 coronary artery occurred in 2%, 6%, 6%, and 9% of cases, respectively (P = 0.06). In pairwise comparisons, the incidence of the primary endpoint was significantly higher for the SAPIEN 3/Ultra compared with all tall-frame THVs (P < 0.001). Among tall-frame devices, no significant difference was observed between the ACURATE neo/neo2 and the Portico or Navitor (P = 0.9), but both devices demonstrated higher rates of the primary endpoint than the Evolut Pro/Pro+ (P = 0.005 and P = 0.002, respectively). Multivariate analysis identified implantation depth, moderate or severe commissural misalignment, and use of a tall-frame THV as independent predictors of unfeasible or nonselective CA. Conclusions: The short-frame SAPIEN 3/Ultra THV demonstrated the highest rate of selective CA following TAVR. Among tall-frame THVs, the large-cell designs of the Portico or Navitor and ACURATE neo/neo2 outperformed the closed-cell Evolut Pro/Pro+ in terms of selective CA.
KW - aortic stenosis
KW - coronary access
KW - coronary artery disease
KW - transcatheter aortic valve replacement
KW - aortic stenosis
KW - coronary access
KW - coronary artery disease
KW - transcatheter aortic valve replacement
UR - https://publicatt.unicatt.it/handle/10807/318238
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=105008152985&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=105008152985&origin=inward
U2 - 10.1016/j.jcin.2025.05.002
DO - 10.1016/j.jcin.2025.05.002
M3 - Article
SN - 1936-8798
VL - 18
SP - 1571
EP - 1583
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 12
ER -
