Feasibility of coronary access after transcatheter aortic valve implantation (TAVI): a systematic review and meta-analysis of observational studies

Introduction: The expanding indications for transcatheter aortic valve implatation (TAVI) to younger, lower-risk patients, entails assessing not only the short-term clinical outcomes but also the long-term considerations for future interventions. The prevalence of coronary artery disease (CAD) in TAVI patients is relevant, and the optimal timing of percutaneous coronary intervention (PCI) remains a question. Methods: We conducted a systematic literature review and meta analysis including 20 eligible studies involving 1660 patients who underwent coronary angiography after TAVI. The primary endpoint was the incidence of successful selective coronary re-access. Secondary endpoints included semi-selective and non-selective access rates. The analysis was stratified by balloon-expandable (BEVs) and self-expandable valve (SEVs) types. Results: Successful coronary access after TAVI was feasible in the majority of patients, with a higher success rate observed for the left main (LM) compared to the right coronary artery (RCA). BEVs demonstrated the highest success rates in coronary ostia cannulation, achieving nearly 100% success for both LM and RCA. Among SEVs, the Acurate Neo and Evolut R/PRO showed superior success rates in selective coronary access (68% and 77% for LM; 57% and 72% for RCA, respectively) compared to the CoreValve (46% for LM and 49% for RCA). Notably, the majority of coronary angiograms were performed due to acute coronary syndrome, primarily non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (UA). Conclusions: Selective coronary engagement after TAVI is generally achievable, with BEVs demonstrating superior success rates compared to SEVs. Among SEVs, the Acurate NEO showed better outcomes than the other types.