TY - JOUR
T1 - Feasibility of redo-TAVI in self-expanding Evolut valves
T2 - a CT analysis from the Evolut Low Risk Trial substudy
AU - Grubb, Kendra J.
AU - Shekiladze, Nikoloz
AU - Spencer, Julianne
AU - Perdoncin, Emily
AU - Tang, Gilbert H.L.
AU - Xie, Joe
AU - Lisko, John
AU - Sanchez, Jorge Zhingre
AU - Lucas, Lindsay M.
AU - Sathananthan, Janarthanan
AU - Rogers, Toby
AU - Michael Deeb, G.
AU - Fukuhara, Shinichi
AU - Blanke, Philipp
AU - Leipsic, Jonathon A.
AU - Forrest, John K.
AU - Reardon, Michael J.
AU - Gleason, Patrick
N1 - Funding Information:
This work was supported by Medtronic, MN, USA.
Publisher Copyright:
© Europa Digital & Publishing 2023. All rights reserved.
PY - 2023/7
Y1 - 2023/7
N2 - BACKGROUND: Transcatheter aortic valve implantation in an existing transcatheter valve (redo-TAVI) pins the index valve leaflets in the open position (neoskirt), which can cause coronary flow compromise and limit access. Whether anatomy may preclude redo-TAVI in self-expanding Evolut valves is unknown.AIMS: We aimed to evaluate the anatomical feasibility of redo-TAVI by simulating implantation of a balloon-expandable SAPIEN 3 (S3) within an Evolut or an Evolut within an Evolut.METHODS: A total of 204 post-TAVI computed tomography (CT) scans from the Evolut Low Risk CT substudy were analysed. Five redo-TAVI positions were evaluated: S3-in-Evolut inflow-to-inflow, S3 outflow at Evolut nodes 4, 5, and 6, and Evolut-in-Evolut inflow-to-inflow. Univariable modelling identified pre-TAVI clinical characteristics, CT anatomical parameters, and procedural variables associated with coronary flow compromise using the neoskirt height and post-TAVI aortic root dimensions.RESULTS: The risk of coronary flow compromise was lowest when the S3 outflow was at Evolut node 4 (20%) and highest when at Evolut node 6 (75%). The highest likelihood of preserving coronary accessibility occurred with the S3 outflow at Evolut node 4. Female sex and higher body mass index were associated with a higher risk of coronary flow compromise, as were a smaller annulus diameter, lower sinus of Valsalva height and width, shorter coronary height, smaller sinotubular junction diameter, and shallower Evolut implant depth.CONCLUSIONS: The feasibility of redo-TAVI after Evolut failure is multifactorial and relates to the native annular anatomy, as well as the implantation depth of the index and second bioprostheses. Placement of an S3 at a lower Evolut position may reduce the risk of coronary flow compromise while preserving coronary access.CLINICALTRIALS: gov: NCT02701283.
AB - BACKGROUND: Transcatheter aortic valve implantation in an existing transcatheter valve (redo-TAVI) pins the index valve leaflets in the open position (neoskirt), which can cause coronary flow compromise and limit access. Whether anatomy may preclude redo-TAVI in self-expanding Evolut valves is unknown.AIMS: We aimed to evaluate the anatomical feasibility of redo-TAVI by simulating implantation of a balloon-expandable SAPIEN 3 (S3) within an Evolut or an Evolut within an Evolut.METHODS: A total of 204 post-TAVI computed tomography (CT) scans from the Evolut Low Risk CT substudy were analysed. Five redo-TAVI positions were evaluated: S3-in-Evolut inflow-to-inflow, S3 outflow at Evolut nodes 4, 5, and 6, and Evolut-in-Evolut inflow-to-inflow. Univariable modelling identified pre-TAVI clinical characteristics, CT anatomical parameters, and procedural variables associated with coronary flow compromise using the neoskirt height and post-TAVI aortic root dimensions.RESULTS: The risk of coronary flow compromise was lowest when the S3 outflow was at Evolut node 4 (20%) and highest when at Evolut node 6 (75%). The highest likelihood of preserving coronary accessibility occurred with the S3 outflow at Evolut node 4. Female sex and higher body mass index were associated with a higher risk of coronary flow compromise, as were a smaller annulus diameter, lower sinus of Valsalva height and width, shorter coronary height, smaller sinotubular junction diameter, and shallower Evolut implant depth.CONCLUSIONS: The feasibility of redo-TAVI after Evolut failure is multifactorial and relates to the native annular anatomy, as well as the implantation depth of the index and second bioprostheses. Placement of an S3 at a lower Evolut position may reduce the risk of coronary flow compromise while preserving coronary access.CLINICALTRIALS: gov: NCT02701283.
KW - TAVI
KW - aortic stenosis
KW - valve-in-valve
KW - Humans
KW - Heart Valve Prosthesis
KW - Tomography, X-Ray Computed
KW - Treatment Outcome
KW - Prosthesis Design
KW - Feasibility Studies
KW - Aortic Valve Stenosis/diagnostic imaging
KW - Transcatheter Aortic Valve Replacement/methods
KW - Female
KW - Aortic Valve/diagnostic imaging
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U2 - 10.4244/EIJ-D-22-01125
DO - 10.4244/EIJ-D-22-01125
M3 - Article
C2 - 37067193
AN - SCOPUS:85164978367
SN - 1774-024X
VL - 19
SP - E330-E339
JO - EuroIntervention
JF - EuroIntervention
IS - 4
ER -