Feasibility of Coronary Access Following Redo-TAVR for Evolut Failure: A Computed Tomography Simulation Study

Gilbert H.L. Tang, Julianne Spencer, Toby Rogers, Kendra J. Grubb, Patrick Gleason, Hemal Gada, Paul Mahoney, Harold L. Dauerman, John K. Forrest, Michael J. Reardon, Philipp Blanke, Jonathon A. Leipsic, Mohamed Abdel-Wahab, Guilherme F. Attizzani, Rishi Puri, Michael Caskey, Christine J. Chung, Ying Hwa Chen, Dariusz Dudek, Keith B. AllenAdnan K. Chhatriwalla, Wah Wah Htun, Daniel J. Blackman, Giuseppe Tarantini, Jorge Zhingre Sanchez, Greta Schwartz, Jeffrey J. Popma, Janarthanan Sathananthan

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

BACKGROUND: Coronary accessibility following redo-transcatheter aortic valve replacement (redo-TAVR) is increasingly important, particularly in younger low-risk patients. This study aimed to predict coronary accessibility after simulated Sapien-3 balloon-expandable valve implantation within an Evolut supra-annular, self-expanding valve using pre-TAVR computed tomography (CT) imaging. METHODS: A total of 219 pre-TAVR CT scans from the Evolut Low-Risk CT substudy were analyzed. Virtual Evolut and Sapien-3 valves were sized using CT-based diameters. Two initial Evolut implant depths were analyzed, 3 and 5 mm. Coronary accessibility was evaluated for 2 Sapien-3 in Evolut implant positions: Sapien-3 outflow at Evolut node 4 and Evolut node 5. RESULTS: With a 3-mm initial Evolut implant depth, suitable coronary access was predicted in 84% of patients with the Sapien-3 outflow at Evolut node 4, and in 31% of cases with the Sapien-3 outflow at Evolut node 5 (P<0.001). Coronary accessibility improved with a 5-mm Evolut implant depth: 97% at node 4 and 65% at node 5 (P<0.001). When comparing 3- to 5-mm Evolut implant depth, sinus sequestration was the lowest with Sapien-3 outflow at Evolut node 4 (13% versus 2%; P<0.001), and the highest at Evolut node 5 (61% versus 32%; P<0.001). CONCLUSIONS: Coronary accessibility after Sapien-3 in Evolut redo-TAVR relates to the initial Evolut implant depth, the Sapien-3 outflow position within the Evolut, and the native annular anatomy. This CT-based quantitative analysis may provide useful information to inform and refine individualized preprocedural CT planning of the initial TAVR and guide lifetime management for future coronary access after redo-TAVR. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02701283.

Original languageEnglish (US)
Pages (from-to)E013238
JournalCirculation: Cardiovascular Interventions
Volume16
Issue number11
DOIs
StatePublished - Nov 1 2023

Keywords

  • balloon-expandable valve
  • coronary access
  • implant depth
  • self-expanding valve
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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