Direct Visualization of TAVR-Related Coronary Artery Management Techniques in Reanimated Beating Hearts

Despite improvements in transcatheter aortic valve replacement (TAVR), post-TAVR percutaneous coronary intervention and periprocedural coronary occlusion represent major issues. To assess the interactions between TAVR prostheses, coronary ostia, and percutaneous coronary intervention devices, we tested TAVR-related coronary techniques using Visible Heart methodologies (1). This study complied with the guidelines by the Institutional Animal Care and Use Committee (University of Minnesota). The selected TAVR system was Evolut self-expandable prosthesis (Medtronic, Minneapolis, Minnesota). Procedures were conducted under fluoroscopic guidance by 2 expert interventional cardiologists, while endoscopic visualization was simultaneously recorded. Coronary cannulation and percutaneous coronary intervention were performed after single Evolut self-expandable prosthesis implantation and after transcatheter aortic valve–in–transcatheter aortic valve. The collected endoscopic footages highlighted the jailed coronary artery ostia appearance and the optimal cannulation achieved in challenging scenarios (Figures 1 and 2, Videos 1 and 2). Furthermore, 2 stent-based techniques for intraprocedural coronary occlusion prevention/management were tested. In particular, the “classic” chimney/snorkel procedure and the novel orthotopic snorkel stenting technique (2) were directly visualized and the obtained results were assessed by micro–computed tomograph