Flaring of Protruding Coronary Stents Before Transcatheter Aortic Valve Replacement to Minimize Interaction-A Feasibility Study.

Abstract

Background: Protruding coronary artery stents can adversely affect transcatheter aortic valve replacement (TAVR) procedure. Current evidence on the topic is limited.

Aims: We aim to study the clinical feasibility and safety of flaring of protruding coronary artery stents before TAVR to reduce interaction with transcatheter heart valves.

Methods: Twenty consecutive patients with 22 protruding coronary stents were optimized with a dual-diameter balloon before TAVR. Procedural success, stent and valve geometry on angiogram, periprocedural and subsequent clinical outcomes as well as valve hemodynamics on echocardiography were evaluated.

Results: Procedural success was achieved in 100% of coronary procedure and TAVR without any major complication directly related to the flaring of stents. There was no coronary artery obstruction after TAVR or visible stent or valve deformity. All valves had normal hemodynamics immediately post-deployment with none having clinically significant aortic insufficiency. One patient had inpatient mortality unrelated to coronary stent optimization. One valve had hemodynamic valve degeneration on follow-up which was unrelated to coronary stent flaring and the patient was asymptomatic.

Conclusion: Flaring of protruding coronary stents before TAVR is technically feasible and safe and can potentially minimize stent-valve interaction for during of after TAVR.