TY - JOUR
T1 - Coronary Access Following Redo TAVR
T2 - Impact of THV Design, Implant Technique, and Cell Misalignment
AU - Meier, David
AU - Akodad, Mariama
AU - Landes, Uri
AU - Barlow, Aaron M.
AU - Chatfield, Andrew G.
AU - Lai, Althea
AU - Tzimas, Georgios
AU - Tang, Gilbert H.L.
AU - Puehler, Thomas
AU - Lutter, Georg
AU - Leipsic, Jonathon A.
AU - Søndergaard, Lars
AU - Wood, David A.
AU - Webb, John G.
AU - Sellers, Stephanie L.
AU - Sathananthan, Janarthanan
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/8/8
Y1 - 2022/8/8
N2 - Background: The implications and potential challenges of coronary access after redo transcatheter aortic valve replacement (TAVR) are unknown. Objectives: The authors sought to evaluate the impact of different transcatheter heart valve (THV) designs, neoskirt height, implant technique, and cell misalignment on coronary access after redo TAVR. Methods: Different THV designs (Sapien 3 [Edwards Lifesciences LLC], Evolut Pro [Medtronic], ACURATE neo [Boston Scientific Corporation], and Portico [Abbott Structural Heart]) and sizes were implanted inside Sapien XT (Edwards Lifesciences LLC) and Evolut R (Medtronic) THVs, which were modeled as the “failed” THVs, at different implant depths. Valve combinations underwent micro–computed tomography to determine the neoskirt height and dimensions of the lowest accessible cell for potential coronary access. This was compared with dimensions of 6-F/7-F/8-F coronary guiding catheters. Results: Redo TAVR combinations resulted in a wide range of neoskirt heights (15.4-31.6 mm) and a variable diameter of the lowest accessible cell (1.9-21.8 mm). An ACURATE neo implanted in a Sapien XT resulted in the largest accessible cells, whereas a Portico implanted in a Sapien XT resulted in the lowest neoskirt heights. The smallest accessible cell was observed in the Evolut Pro–in–Evolut R configuration with higher neoskirt heights. Redo TAVR in a tall frame valve with supra-annular leaflets caused a taller neoskirt height. In Evolut-in-Evolut combinations, misalignment of the cells of the 2 THVs reduced the cell area by 30% to 50% compared with an aligned configuration. Conclusions: This study demonstrates that different redo TAVR combinations are not equivalent in terms of future coronary access. Redo TAVR using a tall frame valve in a failed tall frame valve and misaligned cells may lead to potentially challenging coronary access.
AB - Background: The implications and potential challenges of coronary access after redo transcatheter aortic valve replacement (TAVR) are unknown. Objectives: The authors sought to evaluate the impact of different transcatheter heart valve (THV) designs, neoskirt height, implant technique, and cell misalignment on coronary access after redo TAVR. Methods: Different THV designs (Sapien 3 [Edwards Lifesciences LLC], Evolut Pro [Medtronic], ACURATE neo [Boston Scientific Corporation], and Portico [Abbott Structural Heart]) and sizes were implanted inside Sapien XT (Edwards Lifesciences LLC) and Evolut R (Medtronic) THVs, which were modeled as the “failed” THVs, at different implant depths. Valve combinations underwent micro–computed tomography to determine the neoskirt height and dimensions of the lowest accessible cell for potential coronary access. This was compared with dimensions of 6-F/7-F/8-F coronary guiding catheters. Results: Redo TAVR combinations resulted in a wide range of neoskirt heights (15.4-31.6 mm) and a variable diameter of the lowest accessible cell (1.9-21.8 mm). An ACURATE neo implanted in a Sapien XT resulted in the largest accessible cells, whereas a Portico implanted in a Sapien XT resulted in the lowest neoskirt heights. The smallest accessible cell was observed in the Evolut Pro–in–Evolut R configuration with higher neoskirt heights. Redo TAVR in a tall frame valve with supra-annular leaflets caused a taller neoskirt height. In Evolut-in-Evolut combinations, misalignment of the cells of the 2 THVs reduced the cell area by 30% to 50% compared with an aligned configuration. Conclusions: This study demonstrates that different redo TAVR combinations are not equivalent in terms of future coronary access. Redo TAVR using a tall frame valve in a failed tall frame valve and misaligned cells may lead to potentially challenging coronary access.
KW - TAVR
KW - coronary access
KW - redo-TAVR
KW - valve-in-valve
UR - http://www.scopus.com/inward/record.url?scp=85135070067&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2022.05.005
DO - 10.1016/j.jcin.2022.05.005
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C2 - 35926919
AN - SCOPUS:85135070067
SN - 1936-8798
VL - 15
SP - 1519
EP - 1531
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 15
ER -