Transcatheter aortic valve implantation (TAVI)

Post-TAVI coronary access considerations

Optimize your approach. See how the Evolut™ platform sets the stage for successful post-TAVI coronary access.

Evolut and future coronary access

The design of the Evolut™ frame, together with minor procedural adjustments and catheter selection based on the patient’s anatomy, helps facilitate post-TAVI coronary access. Highlights of this unique frame design include:

Frame support — The frame reduces the need for additional backup catheters with more aggressive shapes.
Narrow waist — This allows more space between the frame and the coronary ostia.
Frame cell size — Cells are sized to accommodate all standard coronary access tools up to 10 Fr.

Evolut transcatheter aortic valve with catheter accessing the coronary shown with three numbers as callouts

Tailoring the procedure

With a few essential considerations, you can access coronaries through the Evolut™ frame, optimize post-TAVI coronary access procedures, and approach these cases with confidence.

1. Perform aortogram

X-ray of pigtail catheter inserted within an Evolut valve frame during a TAVR/TAVI procedure

Insert pigtail within Evolut™ frame, choose an orthogonal view of desired coronary, and perform an aortogram.

2. Select catheter

X-ray of catheter shape selected for perpendicular crossing of the valve frame for a post-TAVR/TAVI PCI procedure

Exchange to catheter shape based on root size/shape and location of commissure; downsize by 0.5 cm.

3. Approach coaxially

X-ray depicting the coronary artery approached coaxially during a post-TAVR/TAVI PCI procedure

Approach coronary coaxially, remain perpendicular to frame. Do not approach from below.¹ Use J-wire for aid.

4. Engage and continue

X-ray of the ostium engaged coaxially during a post-TAVR/TAVI PCI procedure

Image courtesy of James Harvey, M.D.

Perform nonselective angio/use guidewire and guide extension devices to reach ostium and perform diagnostic/PCI.

5. Disengage safely

X-ray of a guide catheter removed over a guidewire during a post-TAVR/TAVI PCI procedure

Image courtesy of Harold Dauerman, M.D.

Always disengage catheter/guide over a guidewire.

The considerations for post-TAVI 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-TAVI coronary access.

Download the guidance

High success rate for unplanned PCI²

Unplanned post-TAVI 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 TAVI device.

Incidence of unplanned post-TAVI PCI was rare (0.9%, median follow-up 191 days)
Very high success rate (96.6%) for post-TAVI PCI
No statistical difference in success rates for balloon-expandable versus self-expanding
No statistical difference in the following factors among patients treated with two valve types:
- Number of diagnostic or guiding catheters used
- Total fluoroscopy time
- Vascular access route during PCI

Gaining coronary access through any TAVI device can create complexities. But procedural considerations, commissural alignment, and effective case planning make the process feasible.

Additional resources

Explore commissural alignment

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.

Read the paper

Medtronic Academy

Find valuable education resources designed to enhance your Evolut™ TAVI knowledge. The learning content consists of training modules, live cases, webinars, and more!

Explore the TAVI procedure

Explore our other procedural guidance and outcomes you can expect from the Evolut platform.

Evolut 29 mm transcatheter aortic valve within a circular outline

References

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.

DISCLAIMER

The material on this website should not be considered the exclusive source of information, it does not replace or supersede information contained in the device manual(s).

Please note that the intended use of a product may vary depending on geographical approvals. See the device manual(s) for detailed information regarding the intended use, the implant procedure, indications, contraindications, warnings, precautions, and potential adverse events.

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