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

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. 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. 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). 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. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02701283.

Citation

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 Allen, Adnan K Chhatriwalla, Wah Wah Htun, Daniel J Blackman, Giuseppe Tarantini, Jorge Zhingre Sanchez, Greta Schwartz, Jeffrey J Popma, Janarthanan Sathananthan. Feasibility of Coronary Access Following Redo-TAVR for Evolut Failure: A Computed Tomography Simulation Study. Circulation. Cardiovascular interventions. 2023 Nov;16(11):e013238

Mesh Tags

PMID: 37988439

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