TY - JOUR
T1 - Conventional versus modified delivery system technique in commissural alignment from the Evolut low-risk CT substudy
AU - Tang, Gilbert H.L.
AU - Sengupta, Aditya
AU - Alexis, Sophia L.
AU - Zaid, Syed
AU - Leipsic, Jonathan A.
AU - Blanke, Philipp
AU - Grubb, Kendra J.
AU - Gada, Hemal
AU - Yakubov, Steven J.
AU - Rogers, Toby
AU - Lerakis, Stamatios
AU - Khera, Sahil
AU - Adams, David H.
AU - Sharma, Samin K.
AU - Kini, Annapoorna
AU - Reardon, Michael J.
N1 - Funding Information:
Jane Moore, MS, ELS performed copyediting and assisted with the accuracy of the Medtronic data presented. Jian Huang, MD, MSc performed all Low Risk Trial analyses. Both are employees and shareholders of Medtronic, plc.
Publisher Copyright:
© 2021 Wiley Periodicals LLC.
PY - 2022/2/15
Y1 - 2022/2/15
N2 - OBJECTIVES: We assessed the impact of conventional delivery system (DS) insertion technique on "Hat-marker" orientation/commissural alignment in patients who underwent transcatheter aortic valve replacement (TAVR) in the Evolut Low Risk Trial CT substudy versus a modified technique.BACKGROUND: Unlike surgical aortic valve replacement, where alignment of the surgical valve commissures with native commissures can be achieved virtually 100% of the time, commissural alignment during TAVR is not achieved consistently. This may subsequently impact the feasibility of both coronary access and reintervention after TAVR.METHODS: "Hat-marker" orientations during deployment were characterized as outer curve (OC), center front (CF), inner curve, and center back. Severe commissure-to-CA overlap was 0-20°. "Hat-marker" orientations and CA overlap were compared to 240 patients from a single center using the modified 3-o'clock flush port DS technique.RESULTS: In the CT substudy in which conventional DS insertion was performed (flush port at 12 o'clock); 154/249 had both analyzable CT and procedural fluoroscopy to validate "Hat-marker" to C-tab/commissural orientation. On post-TAVR CT, Evolut valve commissural orientation and coronary artery (CA) ostia were identified. Compared to conventional DS technique in the CT substudy, the modified technique had higher rates of "Hat-marker" at OC/CF orientation, improved commissural alignment and reduced severe CA overlap; (left main, 14.2 vs. 27.9%; right coronary artery, 11.7 vs. 27.3% both, 5.0 vs. 13.6%; 1 or both CA, 20.8 vs. 41.6%, all p < 0.01).CONCLUSIONS: The modified technique improved initial "Hat-marker" orientation during Evolut deployment and resulted in better commissural alignment and reduced CA overlap.
AB - OBJECTIVES: We assessed the impact of conventional delivery system (DS) insertion technique on "Hat-marker" orientation/commissural alignment in patients who underwent transcatheter aortic valve replacement (TAVR) in the Evolut Low Risk Trial CT substudy versus a modified technique.BACKGROUND: Unlike surgical aortic valve replacement, where alignment of the surgical valve commissures with native commissures can be achieved virtually 100% of the time, commissural alignment during TAVR is not achieved consistently. This may subsequently impact the feasibility of both coronary access and reintervention after TAVR.METHODS: "Hat-marker" orientations during deployment were characterized as outer curve (OC), center front (CF), inner curve, and center back. Severe commissure-to-CA overlap was 0-20°. "Hat-marker" orientations and CA overlap were compared to 240 patients from a single center using the modified 3-o'clock flush port DS technique.RESULTS: In the CT substudy in which conventional DS insertion was performed (flush port at 12 o'clock); 154/249 had both analyzable CT and procedural fluoroscopy to validate "Hat-marker" to C-tab/commissural orientation. On post-TAVR CT, Evolut valve commissural orientation and coronary artery (CA) ostia were identified. Compared to conventional DS technique in the CT substudy, the modified technique had higher rates of "Hat-marker" at OC/CF orientation, improved commissural alignment and reduced severe CA overlap; (left main, 14.2 vs. 27.9%; right coronary artery, 11.7 vs. 27.3% both, 5.0 vs. 13.6%; 1 or both CA, 20.8 vs. 41.6%, all p < 0.01).CONCLUSIONS: The modified technique improved initial "Hat-marker" orientation during Evolut deployment and resulted in better commissural alignment and reduced CA overlap.
KW - commissural alignment
KW - self-expanding
KW - supra-annular
KW - transcatheter aortic valve implantation
KW - transcatheter aortic valve replacement
KW - Heart Valve Prosthesis
KW - Humans
KW - Tomography, X-Ray Computed
KW - Transcatheter Aortic Valve Replacement/adverse effects
KW - Treatment Outcome
KW - Prosthesis Design
KW - Aortic Valve Stenosis/diagnostic imaging
KW - Aortic Valve/diagnostic imaging
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U2 - 10.1002/ccd.29973
DO - 10.1002/ccd.29973
M3 - Article
C2 - 34626449
AN - SCOPUS:85116583577
SN - 1522-1946
VL - 99
SP - 924
EP - 931
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 3
ER -