Coronary Artery anomalies in PatienTs Undergoing transcatheter aortic valve REplacement. The CAPTURE registry

Background The incidence and possible implications of coronary artery anomalies (CAA) in patients undergoing transcatheter aortic valve replacement (TAVR) are uncertain. Aims To evaluate the impact of CAA on TAVR outcomes, and to suggest possible strategies to prevent CAA related complications. Methods Among 2,164 consecutive patients who underwent TAVR in our center, 15 (0.69%) were identified to have a CAA, based on pre-operative Computed Tomography (CT) scans. Results CT-angiography revealed the following features of CAA: the majority of anomalous CAA concerned the right coronary artery (80%), followed by the left main (13.3%) and the left circumflex (6.7%). An intramural course was observed only in 26.7% patients, whereas an acute take-off was detected in more than half of the study cohort (53.3%). High-risk sudden cardiac death features were observed in 6 (40%) patients. Technical success was 86.7%, device success was 80%. One patient experienced a cardiac arrest 15 minutes after procedure, resulting from occlusion of the anomalous right coronary artery with the ostium located at the right-to-non coronary commissure. There were no cases of ≥ moderate paravalvular leak or stroke. One non-cardiac related death was recorded 4 months after the procedure. Conclusions The interaction between transcatheter bioprosthesis and different CAA types could lead to ominous sequelae, if not promptly recognized and treated accordingly.