Tomoki Ochiai1, Tarun Chakravarty2, Sung-Han Yoon2, Danon Kaewkes2, Nir Flint3, Vivek Patel2, Sahar Mahani2, Ripandeep Tiwana2, Navjot Sekhon2, Mamoo Nakamura2, Wen Cheng2, Raj Makkar4. 1. Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan. Electronic address: https://twitter.com/TomokiOchiai. 2. Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. 3. Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: raj.makkar@cshs.org.
Abstract
OBJECTIVES: The aim of this study was to assess the incidence of unfavorable coronary access after transcatheter aortic valve replacement (TAVR) using post-implantation computed tomography (CT). BACKGROUND: Real-world data regarding coronary access after TAVR assessed using post-implantation CT are scarce. METHODS: Post-TAVR CT of 66 patients treated with Evolut R or Evolut PRO valves and 345 patients treated with SAPIEN 3 valves were analyzed. The distance from inflow of the transcatheter heart valve (THV) to the coronary ostia and the overlap between THV commissures and the coronary ostia were assessed. Coronary access was defined as unfavorable if the coronary ostium was below the skirt or in front of the THV commissural posts above the skirt in each coronary artery. RESULTS: CT-identified features of unfavorable coronary access were observed in 34.8% (n = 23) for the left coronary artery and 25.8% (n = 17) for the right coronary artery in the Evolut R/Evolut PRO group, while those percentages were 15.7% (n = 54) for the left coronary artery and 8.1% (n = 28) for the right coronary artery in the SAPIEN 3 group. In the Evolut R/Evolut PRO group, 16 coronary engagements were performed after TAVR, while 64 coronary engagements were performed in the SAPIEN 3 group after TAVR. In an engagement-level analysis, the success rates of selective coronary engagement were significantly lower in patients with CT-identified features of unfavorable coronary access compared with those with favorable coronary access in both the Evolut R/Evolut PRO (0.0% vs. 77.8%; p = 0.003) and SAPIEN 3 (33.3% vs. 91.4%; p = 0.003) groups. CONCLUSIONS: Coronary access may be challenging in a significant proportion of patients after TAVR. THVs with low skirt or commissure height and large open cells that are designed to achieve commissure-to-commissure alignment with the native aortic valve may facilitate future coronary access. (Assessment of Transcatheter and Surgical Aortic Bioprosthetic Valve Thrombosis and Its Treatment With Anticoagulation [RESOLVE]; NCT02318342).
OBJECTIVES: The aim of this study was to assess the incidence of unfavorable coronary access after transcatheter aortic valve replacement (TAVR) using post-implantation computed tomography (CT). BACKGROUND: Real-world data regarding coronary access after TAVR assessed using post-implantation CT are scarce. METHODS: Post-TAVR CT of 66 patients treated with Evolut R or Evolut PRO valves and 345 patients treated with SAPIEN 3 valves were analyzed. The distance from inflow of the transcatheter heart valve (THV) to the coronary ostia and the overlap between THV commissures and the coronary ostia were assessed. Coronary access was defined as unfavorable if the coronary ostium was below the skirt or in front of the THV commissural posts above the skirt in each coronary artery. RESULTS: CT-identified features of unfavorable coronary access were observed in 34.8% (n = 23) for the left coronary artery and 25.8% (n = 17) for the right coronary artery in the Evolut R/Evolut PRO group, while those percentages were 15.7% (n = 54) for the left coronary artery and 8.1% (n = 28) for the right coronary artery in the SAPIEN 3 group. In the Evolut R/Evolut PRO group, 16 coronary engagements were performed after TAVR, while 64 coronary engagements were performed in the SAPIEN 3 group after TAVR. In an engagement-level analysis, the success rates of selective coronary engagement were significantly lower in patients with CT-identified features of unfavorable coronary access compared with those with favorable coronary access in both the Evolut R/Evolut PRO (0.0% vs. 77.8%; p = 0.003) and SAPIEN 3 (33.3% vs. 91.4%; p = 0.003) groups. CONCLUSIONS: Coronary access may be challenging in a significant proportion of patients after TAVR. THVs with low skirt or commissure height and large open cells that are designed to achieve commissure-to-commissure alignment with the native aortic valve may facilitate future coronary access. (Assessment of Transcatheter and Surgical Aortic Bioprosthetic Valve Thrombosis and Its Treatment With Anticoagulation [RESOLVE]; NCT02318342).
Authors: Mariama Akodad; Anthony Chuang; Abdul Ihdayhid; Andrew G Chatfield; Jonathon Leipsic; Anson Cheung; David A Wood; Anthony Della Siega; M Bilal Iqbal; John G Webb; Janarthanan Sathananthan Journal: CJC Open Date: 2022-02-01
Authors: Nils Perrin; Amir Fassa; Antoine Baroz; Caroline Frangos; Stephane Mock; Angela Frei; Murat Cimci; Sophie Degrauwe; Marco Roffi; Juan Fernando Iglesias; Stephane Noble Journal: Cardiol J Date: 2020-05-21 Impact factor: 2.737