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

• Type of Material: Article
• Authors: Gilbert H.L. Tang, Mount Sinai Health System; Julianne Spencer, Medtronic; toby Rogers, MedStar Washington Hospital Center; Kendra Grubb, Emory University; Patrick Thomas Gleason, Emory University; Hemal Gada, University of Pittsburgh; Paul Mahoney, Sentara Heart Hospital; Harold L. Dauerman, University of Vermont; John K. Forrest, Yale University; Michael J. Reardon, Houston Methodist; Philipp Blanke, University of British Columbia; Jonathon A. Leipsic, University of British columbia; Mohamed Abdel-Wahab, University of Leipzig; Guilherme Attizzani, University Hospitals Cleveland Medical Center; Rishi Puri, Cleveland Clinic; Michael Caskey, Abrazo Arizona Heart Hospital; Christine J. Chung, University of Washington, Seattle; Ying-Hwa Chen, Taipei Veterans General Hospital; Dariusz Dudek, Jagiellonian University; Keith B. Allen, St. Luke's Mid America Heart Institute; Adnan K. Chhatriwalla, St. Luke's Mid America Heart Institute; Wah Wah Htun, Gundersen Health System; Daniel J. Blackman, Leeds Teaching Hospitals; Giuseppe Tarantini, University of Padua; Jorge Zhingre Sanchez, Medtronic; Greta Schwartz, Medtronic; Jeffrey J. Popma, Medtronic; Janarthanan Sathananthan, University of British Columbia
• Language: English
• Date: 2023-11-21
• Publisher: Wolters Kluwer
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1161/CIRCINTERVENTIONS.123.013238
• Title of Journal or Parent Work: Circulation: Cardiovascular Interventions
• Volume: 16
• Issue: 11
• Start Page: e013238
• Grant/Funding Information: This work was supported by Medtronic, United States.
• Keywords: self-expanding valve; implant depth; transcatheter aortic valve replacement; coronary access; balloon-expandable valve
• Research Categories: Health Sciences, Medicine and Surgery

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.