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 - 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
UR - https://www.scopus.com/pages/publications/85116583577
UR - https://www.scopus.com/inward/citedby.url?scp=85116583577&partnerID=8YFLogxK
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 -