The Coronary Access After TAVI (CAvEAT) Study A Prospective Registry of CA After TAVR
Por:
Tarantini, G, Fovino, LN, Belloni, F, Barbierato, M, Gallo, F, Vercellino, M, Trani, C, Burzotta, F, Serra, LA, Petronio, AS, Bedogni, F, Berti, S, Bertolini, A, Fabris, T, Tito, A, Musto, C, Giordano, A, Corcione, N, Maisano, F, Medda, M, Loi, B, Cernetti, C, Favero, L, Di Lorenzo, E, Gregori, D, Lorenzoni, G, Orzalkiewicz, M, Esposito, G, Saia, F, Cardaioli, F, Marchese, A
Publicada:
23 jun 2025
Ahead of Print:
1 jun 2025
Resumen:
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. (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Filiaciones:
Tarantini, G:
Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Via Giustiniani 2, I-35128 Padua, Italy
Fovino, LN:
Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Via Giustiniani 2, I-35128 Padua, Italy
Belloni, F:
S Spirito Hosp, Rome, Italy
Barbierato, M:
Osped Angelo, AULSS3 Serenissima, Dept Cardiol, Venice, Venice, Italy
Gallo, F:
Osped Angelo, AULSS3 Serenissima, Dept Cardiol, Venice, Venice, Italy
Vercellino, M:
Osped San Martino Genova, Dept Cardiovasc Sci, Genoa, Italy
Trani, C:
Univ Cattolica Sacro Cuore, Fdn Policlin A Gemelli IRCCS, Rome, Italy
Burzotta, F:
Univ Cattolica Sacro Cuore, Fdn Policlin A Gemelli IRCCS, Rome, Italy
San Donato Hosp, Dept Clin Cardiol, Milan, Italy
Serra, LA:
Hosp Santa Creu & Sant Pau, IIB St Pau, Cardiol Dept, Barcelona, Spain
Petronio, AS:
Univ Pisa, Cardiac Catheterizat Lab, Pisa, Italy
Azienda Osped Univ Pisana, Pisa, Italy
Berti, S:
Osped Cuore, Fdn Toscana G Monasterio, Massa, Italy
Bertolini, A:
Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Via Giustiniani 2, I-35128 Padua, Italy
Fabris, T:
Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Via Giustiniani 2, I-35128 Padua, Italy
Tito, A:
Osped S Maria, GVM Care & Res, Intervent Cardiol Unit, Bari, Italy
Musto, C:
AO San Camillo Forlanini Hosp, Dept Cardiosci, Rome, Italy
Giordano, A:
Pineta Grande Hosp, Intervent Cardiol Unit, Castel Volturno, Caserta, Italy
Corcione, N:
Pineta Grande Hosp, Intervent Cardiol Unit, Castel Volturno, Caserta, Italy
Maisano, F:
IRCCS San Raffaele Sci Inst, Heart Valve Ctr, Milan, Italy
Medda, M:
IRCCS Osped Galeazzi St Ambrogio, UO Cardiol Osped, Milan, Italy
Loi, B:
Brotzu Hosp, Intervent Cardiol Unit, Cagliari, Italy
Cernetti, C:
Ca Foncello & San Giacomo Hosp Azienda, Cardioneurovasc Dept, Treviso, Italy
Favero, L:
Ca Foncello & San Giacomo Hosp Azienda, Cardioneurovasc Dept, Treviso, Italy
Di Lorenzo, E:
AORN Colli Monaldi Hosp, Dept Cardiol, Naples, Italy
Gregori, D:
Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Unit Biostat Epidemiol & Publ Hlth, Padua, Italy
Orzalkiewicz, M:
Univ Bologna, St Orsola Malpighi Hosp, Dept Med & Surg Sci, Unit Cardiol, Bologna, Italy
Esposito, G:
Univ Federico II, Dept Adv Biomed Sci, Naples, Italy
Saia, F:
Univ Bologna, St Orsola Malpighi Hosp, Dept Med & Surg Sci, Unit Cardiol, Bologna, Italy
Cardaioli, F:
Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Via Giustiniani 2, I-35128 Padua, Italy
Marchese, A:
Osped S Maria, GVM Care & Res, Intervent Cardiol Unit, Bari, Italy
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