Maintaining future coronary access is an important consideration in contemporary TAVI. A multicentre prospective evaluation reported in EuroIntervention assessed feasibility of CC and the influence of commissural and coronary alignment following implantation with a self-expanding valve system.

The study enrolled 126 adults who underwent transfemoral TAVI, followed by CC and coronary angiography. Post-TAVI computed tomography (CT) quantified commissural and coronary alignment. Moderate to severe misalignment, classified using ALIGN-TAVR Consortium definitions, formed a predefined subgroup. The primary endpoint was successful CC after implantation.

CC was successful in 100% of attempts for the LCA and 96.7% for the RCA. Moderate to severe commissural misalignment occurred in 13.5% of cases, while coronary misalignment was identified in 20.6% for the LCA and 22.2% for the RCA. Misaligned coronary takeoffs required significantly longer procedural times.

Multivariable modeling demonstrated that coronary height (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.57–0.90; p=0.006) and coronary misalignment (OR 4.58, 95% CI 1.45–14.47; p=0.009) predicted suboptimal LCA cannulation. For the RCA, right coronary cusp width (OR 0.63, 95% CI 0.44–0.90; p=0.007) and coronary misalignment (OR 4.64, 95% CI 1.29–16.74; p=0.019) were significant predictors.

The findings indicate high overall feasibility of coronary cannulation after self-expanding TAVI. However, coronary misalignment strongly influenced procedural efficiency, supporting continued emphasis on alignment-focused planning and deployment.