0:00

I just wanna take the time to mention, uh, coronary disease. Traditionally, um,

0:05

with tavr, uh,

0:07

standard catheter angiography is performed before the tavr, um, procedure, um,

0:12

to evaluate for any coronary disease that might require stenting or um,

0:17

cabbage. Um, say for instance, um,

0:20

if a patient needed cabbage,

0:22

then that might actually push somebody to get a surgical aortic valve, um,

0:26

rather than a TAVR device, um, because, you know,

0:29

they would be going in there anyways, um, for open heart surgery,

0:32

so you might as well do the cabbage and do the surgical valve at the same time.

0:37

Um, so for that reason,

0:38

it's really important to get a good assessment of the coronary arteries prior to

0:42

performance of the tavr. And like I mentioned, traditionally,

0:46

that has often been done with catheter angiography. However, we know, you know,

0:49

if we're getting a gated ct, uh, of the heart,

0:52

we can certainly look at the coronaries. So, um, that information, um,

0:56

on the pre TAVR CT may allow some patients to avoid cardiac catheterization.

1:01

Um, and the quality of that particular CT depends a lot on patient factors.

1:05

So you can't really get a great coronary evaluation in all your patients.

1:10

Certainly if the heart rate's really high,

1:12

if they have really extensive calcification, um,

1:15

and if their vessel diameters are small, it can be really challenging. Um,

1:19

and particularly because we're not optimizing these patients with beta blockers

1:23

or nitroglycerin. Um, however, people have done,

1:28

uh, studies to look at this and see how often, um, you know,

1:32

patients coronaries can be evaluated by tavr. And, um,

1:36

this study done back in 2015 in radiology,

1:39

they found that in up to one third of TAVR patients,

1:42

you can avoid catheter angiography based on a negative cardiac ct.

1:45

So the most valuable part I think,

1:48

of assessing the coronaries in TAVR is if you do perform the assessment, um,

1:53

it's good for ruling out a significant disease. Uh, if you see some disease,

1:57

then generally those patients, um,

1:59

may need to go to catheter angiography for further evaluation. Um,

2:03

but certainly, um, there's a subset of patients based on this, uh, research,

2:07

maybe up to around a third of patients that, um, you know, you can assess,

2:11

you can say there's no significant disease,

2:13

and then they can avoid the catheter angio, um,

2:17

in these patients prior to the procedure.

2:19

This is an important conversation to have with your, uh,

2:22

interventionalists that you work with. And, um, certainly at our place,

2:25

we don't do routine coronary assessment on every patient. Um,

2:28

but it's something that may be on, um, certain sub uh, groups of your patients.

2:33

You can do the evaluation, you know, just an important conversation to have and,

2:37

and figure out your best approach, uh, that works for your institution.