top of page
Search

TAVR Procedure and Coronary Obstruction: Planning Beyond the Basics

  • drhareshmehta
  • Jul 30
  • 1 min read
Illustration of a heart with text overlay: "TAVR Procedure in Coronary Obstruction: Planning." Background shows a blurred hallway.
TAVR Procedure and Coronary Obstruction: Planning Beyond the Basics

Coronary obstruction remains one of the most feared complications of TAVR procedures, even if rare, with an incidence of ~0.4% in native valve cases. The key lies not in reacting, but in anticipating.


  1. Anatomical factors that increase risk


• Small sinuses of Valsalva

• Low coronary heights

• High valve implantation

• Supra-annular valve positions

• Bulky or heavily calcified native leaflets

• Low VTC/VTA distances, particularly in ViV cases


  1. Bicuspid valves

    ⁠

Bicuspid valves often bring a combination of these challenges, especially bulky, eccentric leaflets that can jeopardise coronary flow, making pre-procedural CT analysis essential.


  1. Flow compromised


When flow is compromised and can’t be restored, bailout strategies include snaring or retrieval using an oversized balloon. But ideally, we aim not to bail out, but to build in protection.


  1. BASILICA and Unicorn


Techniques like BASILICA and Unicorn offer a proactive solution, especially in high-risk leaflets. And in anatomies where coronary access is likely to be restricted post-TAVI, the chimney can provide reliable protection when timed and executed precisely.


  1. Note on TAVR procedure for coronary obstruction


It’s not just about managing complications: it’s about foreseeing them.


Comments

bottom of page