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Background Transcatheter aortic valve replacement (TAVR)‐in‐TAVR is a possible treatment for transcatheter heart valve (THV ) degeneration. However, the displaced leaflets of the firstTHV will create a risk plane (RP ) under which the passage of a coronary catheter will be impossible. The aim of our study was to evaluate the potential risk of impaired coronary access (CA ) afterTAVR ‐in‐TAVR .Methods and Results We prospectively performed coronary angiography afterTAVR with differentTHV s in 137 consecutive patients, looking where the catheter crossed the valve frame. If coronary cannulation was achieved from below theRP , the distance between valve frame and aortic wall was measured by aortic angiography.CA afterTAVR ‐in‐TAVR was defined as feasible if the catheter passed above theRP , as theoretically feasible if passed under theRP with valve‐to‐aorta distance &gt;2 mm, and as unfeasible if passed under theRP with valve‐to‐aorta distance ≤2 mm. Seventy‐two patients (53%) received a Sapien 3 THV, 26 (19%) received an Evolut Pro/R THV, and 39 (28%) received an Acurate NeoTHV .CA afterTAVR ‐in‐TAVR was considered feasible in 40.9% (68.1%, 19.2%, and 5.1%, respectively;P &lt;0.001), theoretically feasible in 27.7% (8.3%, 42.3%, and 53.8%, respectively;P &lt;0.001), and unfeasible in 31.4% (23.6%, 38.5%, and 41.1%, respectively;P =0.116). Independent predictors of impairedCA afterTAVR ‐in‐TAVR were female sex (odds ratio [OR], 3.99; 95%CI , 1.07–14.86;P =0.040), sinotubular junction diameter (OR, 0.62; 95%CI , 0.48–0.80;P &lt;0.001), and implantation of a supra‐annularTHV (OR, 6.61; 95%CI , 1.98–22.03;P =0.002).Conclusions CA afterTAVR ‐in‐TAVR might be unfeasible in &gt;30% of patients currently treated withTAVR . Patients with a small sinotubular junction and those who received a supra‐annularTHV are at highest risk of potentialCA impairment withTAVR ‐in‐TAVR .

Coronary Angiography After Transcatheter Aortic Valve Replacement (TAVR) to Evaluate the Risk of Coronary Access Impairment After TAVR‐in‐TAVR