WASHINGTON, DC - The use of the Evolut FX, FX+ post-transcatheter aortic valve replacement (TAVR) coronary access is more often successful for the left coronary artery (LCA) than the right coronary artery (RCA), the EPROMT-CA study results show. These data were presented by Lior Lupu, MD, MBA, from MedStar Washington Hospital Center, Washington, DC, during a Late-Breaking Clinical Science session Monday afternoon at Cardiovascular Research Technologies (CRT) 2025. Enhancement of commissural alignment (CA) and improving coronary access after TAVR are two of the primary purposes of the Evolut FX and FX+ valves (Medtronic). The investigators in this study examined coronary access post-TAVR with the use of these valves, and looked at computed tomography (CT)-derived factors that may contribute to selective coronary access. The single-center, prospective EPROMPT-CA study included patients with severe aortic stenosis (AS) from the EPROMPT registry undergoing transfemoral TAVR with the Evolut FX and FX+ valves, along with contemporary CA techniques. Between 30 and 60 days post-TAVR, CT was performed, and the results were quantitatively analyzed for factors contributing to the prediction of coronary access success. The primary endpoint of this study was successful coronary access. A total of 138 patients (Evolut FX, n=103; Evolut FX+, n=35) were included in the study, and 55 patients received post-TAVR CT (all Evolut FX patients). Coronary access was accomplished in 94.2% of cases in the LCA and 82.6% of cases in the RCA. No significant differences in success rates were found between the Evolut FX and FX+ groups, but the Evolut FX+ group (2.9%) had fewer cases of unsuccessful LCA compared with the FX group (6.8%). For LCA access, the FX+ group also required less time (p=0.022), less contrast (p<0.001) and fewer catheters (p=0.010). In LCA cases, 43.7% had moderate or severe coronary misalignment, while the RCA cases had 49.1%. Commissural and coronary alignment did not determine selective coronary access, and CT evaluations, both qualitative and quantitative, did not accurately predict coronary access. Overall, post-TAVR coronary access was more successful in the LCA than the RCA with the use of the Evolut FX and FX+ systems. The FX+ system also reduced the amount of contrast used, and these cases had fewer catheter exchanges. Image Credit: Bailey G. Salimes, CRTonline.org Image Caption: Lior Lupu, MD, MBA, presents during a Late-Breaking Clinical Science session at Cardiovascular Research Technologies (CRT) 2025.