Mohammad Abdelghani1, Martin Landt2, Hussein Traboulsi2, Björn Becker2, Gert Richardt2. 1. Heart Center, Segeberger Kliniken, Bad Segeberg, Germany; Department of Cardiology, Al-Azhar University, Cairo, Egypt; Cardiology Department, the Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: m.abdelghani.nl@gmail.com. 2. Heart Center, Segeberger Kliniken, Bad Segeberg, Germany.
Abstract
OBJECTIVES: The authors sought to estimate possible interference of the Medtronic Evolut R/Pro transcatheter heart valve (THV) frame with coronary access using multislice computed tomography (MSCT) data. BACKGROUND: Lower-risk patients undergoing transcatheter aortic valve replacement (TAVR) endure a high cumulative risk of coronary events, but coronary access can be challenging. METHODS: In 101 patients who received an Evolut R/Pro THV, post-TAVR MSCT (performed at a median of 30 days after TAVR) was used to assess possible interference of the elements of the THV frame with coronary access. RESULTS: The closest cell of the THV frame vertically aligned with the coronary ostium was located opposite the ostium in 58% and 63%, below the ostium in 22% and 30%, or above the ostium in 20% and 7% of left and right coronary arteries, respectively. The free sinus of Valsalva space between the THV frame and the coronary ostium was 0.45 ± 0.17 cm and 0.44 ± 0.17 cm for the left and right coronary arteries, respectively, and showed a stepwise decrease with decreasing THV size (p < 0.001). Bioprosthetic valve commissures were antianatomic (i.e., not aligned with native commissures) in 45 patients (47%), and the commissural post was overlapping a coronary ostium in 15 patients (16%). Two patients (2.0%) had a possible interference of the paravalvular sealing skirt with coronary access. CONCLUSIONS: Using post-TAVR MSCT data, the main mechanism of potential interference of Evolut R/Pro frame with coronary access was an antianatomic commissural post overlapping the coronary ostium.
OBJECTIVES: The authors sought to estimate possible interference of the Medtronic Evolut R/Pro transcatheter heart valve (THV) frame with coronary access using multislice computed tomography (MSCT) data. BACKGROUND: Lower-risk patients undergoing transcatheter aortic valve replacement (TAVR) endure a high cumulative risk of coronary events, but coronary access can be challenging. METHODS: In 101 patients who received an Evolut R/Pro THV, post-TAVR MSCT (performed at a median of 30 days after TAVR) was used to assess possible interference of the elements of the THV frame with coronary access. RESULTS: The closest cell of the THV frame vertically aligned with the coronary ostium was located opposite the ostium in 58% and 63%, below the ostium in 22% and 30%, or above the ostium in 20% and 7% of left and right coronary arteries, respectively. The free sinus of Valsalva space between the THV frame and the coronary ostium was 0.45 ± 0.17 cm and 0.44 ± 0.17 cm for the left and right coronary arteries, respectively, and showed a stepwise decrease with decreasing THV size (p < 0.001). Bioprosthetic valve commissures were antianatomic (i.e., not aligned with native commissures) in 45 patients (47%), and the commissural post was overlapping a coronary ostium in 15 patients (16%). Two patients (2.0%) had a possible interference of the paravalvular sealing skirt with coronary access. CONCLUSIONS: Using post-TAVR MSCT data, the main mechanism of potential interference of Evolut R/Pro frame with coronary access was an antianatomic commissural post overlapping the coronary ostium.
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: Arif A Khokhar; Francesco Ponticelli; Adriana Zlahoda-Huzior; Kailash Chandra; Rossella Ruggiero; Marco Toselli; Francesco Gallo; Alberto Cereda; Alessandro Sticchi; Alessandra Laricchia; Damiano Regazzoli; Antonio Mangieri; Bernhard Reimers; Simone Biscaglia; Carlo Tumscitz; Gianluca Campo; Ghada W Mikhail; Won-Keun Kim; Antonio Colombo; Dariusz Dudek; Francesco Giannini Journal: Front Cardiovasc Med Date: 2022-09-14