Feasibility of coronary access after transcatheter aortic valve implantation (TAVI): a systematic review and meta-analysis of observational studies
Bibliographic record
Abstract
INTRODUCTION: The expanding indications for transcatheter aortic valve implantation (TAVI) to younger, lower-risk patients, entails assessing not only the short-term clinical outcomes but also the long-term considerations for future interventions. The prevalence of coronary artery disease in TAVI patients is relevant, and the optimal timing of percutaneous coronary intervention remains a question. METHODS AND RESULTS: We conducted a systematic literature review and meta-analysis including 20 eligible studies involving 1660 patients who underwent coronary angiography after TAVI. The primary endpoint was the incidence of successful selective coronary re-access. Secondary endpoints included semi-selective and non-selective access rates. The analysis was stratified by balloon-expandable (BEVs) and self-expandable valve (SEVs) types. Successful coronary access after TAVI was feasible in the majority of patients, with a higher success rate observed for the left main (LM) compared to the right coronary artery (RCA). BEVs demonstrated the highest success rates in coronary ostia cannulation, achieving nearly 100% success for both LM and RCA. Among SEVs, the Acurate Neo and Evolut R/PRO showed superior success rates in selective coronary access (68 and 77% for LM; 57 and 72% for RCA, respectively) compared to the CoreValve (46% for LM and 49% for RCA). Notably, the majority of coronary angiograms were performed due to acute coronary syndrome, primarily non-ST-segment elevation myocardial infarction, and unstable angina. CONCLUSION: Selective coronary engagement after TAVI is generally achievable, with BEVs demonstrating superior success rates compared to SEVs. Among SEVs, the Acurate NEO showed better outcomes than the other types.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.013 | 0.029 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".