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Fractional flow reserve in patients with coronary artery disease undergoing TAVI: a prospective analysis

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Abstract

Objectives

To determine the true prevalence of CAD in AS patients, to detect changes of the hemodynamic significance of coronary lesions following TAVI, to explore to what extent FFR-positive CAD might influence outcome and finally to develop a management algorithm for this patient subset.

Methods

From May 2016 to March 2018, diagnostic coronary angiography was performed in 246 patients before TAVI. In the presence of coronary lesions with a diameter stenosis ≥ 50%, FFR was measured. In patients with positive FFR ≤ 0.80, a control angiography was performed 6–8 weeks after TAVI.

Results

The study cohort was 81.0 ± 6.1 years old, 48.4% of the patients were male. 53.3% had concomitant CAD. 35.9% of these patients underwent PCI before TAVI due to functionally significant left main CAD and/or severe stenosis ≥ 90%. 31 patients underwent FFR measurements in cumulative 38 coronary lesions. Prior to TAVI, a negative FFR could be detected in 18 lesions, whereas a positive FFR was found in entirely 20 lesions. A control angiography and FFR measurement was performed in cumulative 13 lesions. Comparing the FFR values, there was no significant difference (0.77 ± 0.04 vs. 0.76 ± 0.08; p = 0.11).

Conclusion

Concomitant CAD was diagnosed in 53.3% of TAVI patients. FFR did not significantly change after TAVI, confirming the validity of FFR to evaluate coronary lesions in this specific clinical setting. Given the low rates of cardiac adverse events, it might therefore be considered to treat coronary stenoses not involving left main and those with a diameter stenosis < 90% after TAVI.

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Abbreviations

AS:

Aortic valve stenosis

CAD:

Coronary artery disease

FFR:

Fractional flow reserve

PCI:

Percutaneous coronary intervention

QCA:

Quantitative coronary analysis

SAVR:

Surgical aortic valve replacement

TAVI:

Transcatheter aortic valve implantation

TEE:

Transesophageal echocardiography

THV:

Transcatheter heart valve

VARC:

Valve Academic Research Consortium

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Author notes

  1. Anja Stundl and Jasmin Shamekhi contributed equally to the manuscript.

Authors and Affiliations

  1. Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Anja Stundl, Jasmin Shamekhi, Svenja Bernhardt, Maximilian Starke, Baravan Al-Kassou, Marcel Weber, Alexander Sedaghat, Eberhard Grube, Georg Nickenig, Nikos Werner & Jan-Malte Sinning

  2. Heart Center, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany

    Hendrik Treede

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  1. Anja Stundl
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Correspondence to Jan-Malte Sinning.

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Conflict of interest

Drs. Sinning, Grube, Nickenig, and Werner receive research grants and speaker honoraria from Medtronic and Edwards Lifesciences. Dr. Grube works as proctor for Medtronic. The other authors report no conflicts.

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Stundl, A., Shamekhi, J., Bernhardt, S. et al. Fractional flow reserve in patients with coronary artery disease undergoing TAVI: a prospective analysis. Clin Res Cardiol 109, 746–754 (2020). https://doi.org/10.1007/s00392-019-01563-2

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  • DOI: https://doi.org/10.1007/s00392-019-01563-2

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