A Computed Tomography Protocol to Evaluate Coronary Artery Disease prior to Transcatheter Aortic Valve Replacement.

Abstract Background Transcatheter aortic valve replacement (TAVR) computed tomography (CTA) images can be used to evaluate coronary artery disease (CAD). Methods We conducted a prospective cohort study of consecutive TAVR patients from November 2019 to February 2021 to evaluate TAVR CTA assessment of CAD on the rate of pre-TAVR invasive angiography. Patients had CTA first or invasive angiography first at the discretion of their treating physician. TAVR CTA scans were categorized as normal/mild CAD, single vessel disease, high risk (multi-vessel or left main disease), or non-diagnostic in patients without prior coronary artery bypass grafting (CABG) and as low risk or high risk in patients with prior CABG. Invasive angiography was recommended pre-TAVR for high risk or non-diagnostic CTA findings. Results TAVR was performed on 354 patients and CTA first was performed in 273 patients and invasive angiography first in 81 patients. Among 231 patients without prior CABG who had CTA first, 22.1% (51/231) had pre-TAVR invasive angiography and 1.3% (3/231) had pre-TAVR revascularization. Normal/mild CAD or single vessel disease was found on CTA in 174 patients of whom, 0.5% (1/174) had high risk disease on invasive angiography. Among 42 patients with prior CABG who had CTA first, 14.3% (6/42) had pre-TAVR invasive angiography and 2.4% (1/42) had pre-TAVR revascularization. Conclusion TAVR CTA CAD evaluation can avoid pre-TAVR invasive angiography in over 70 % of patients while rarely missing high-risk findings. A CTA first strategy to assess CAD should be considered, especially among patients where conservative management of CAD is preferred.