Coronary Access After TAVR

Ochiai, Tomoki; Chakravarty, Tarun; Yoon, Sung‐Han; Kaewkes, Danon; Flint, Nir; Patel, Vivek; Mahani, Sahar; Tiwana, Ripandeep; Sekhon, Navjot; Nakamura, Mamoo; Cheng, Wen; Makkar, Raj

doi:10.1016/j.jcin.2020.01.216

Cited by 121 publications

(81 citation statements)

References 21 publications

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“…either below the pericardial skirt or above the pericardial skirt but in front of the three commissural diamonds or triangles) for the LCA and RCA in 34.8 and 25.8% of cases, respectively. 10 In the same study and based on a similar definition, after TAVR with the Sapien 3 valve (Edwards Lifesciences, CA) access to the LCA and RCA was deemed unfavorable in 15.7 and 8.1% of cases. Similarly, CA was deemed unfavorable in 9-13% of patients following Sapien THV implantation from the low surgical risk TAVR trial.…”

Section: Impact Of Transcatheter Heart Valve Designmentioning

confidence: 99%

“…The impact of THV design on CA has been evaluated in the context of native valve TAVR and for TAVR-in-TAVR procedures but not following ViV-TAVR. [8][9][10] THV design is a key determinant of outcomes following ViV-TAVR for degenerated SBV, as supra-annular THVs are associated with less severe patient-prosthesis mismatch compared to intraannular THVs. 11 The ACURATE neo (Boston Scientific, MA) THV is a supra-annular self-expanding transcatheter valve, with specific design characteristics making it potentially more favorable in re-engaging coronary arteries as compared to other supra-annular THVs in the setting of ViV-TAVR for degenerated SBV (Figure S1).…”

Section: Introductionmentioning

confidence: 99%

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Computed tomography analysis of coronary ostia location following valve‐in‐valve transcatheter aortic valve replacement with the ACURATE neo valve: Implications for coronary access

Khokhar

Laricchia

Ponticelli

et al. 2021

Cathet Cardio Intervent

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Background: Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is an emerging alternative to re-do surgery. However, the challenge of coronary access (CA) following ViV-TAVR is a potential limitation as TAVR expands to younger lowerrisk populations.Objectives: Using post-implantation computed tomography (CT) scans to evaluate the geometrical relationship between coronary ostia and valve frame in patients undergoing ViV-TAVR with the ACURATE neo valve.Methods: Post-implant CT scans of 18 out of 20 consecutive patients treated with the ACURATE neo valve were analyzed. Coronary ostia location in relation to the highest plane (HP) (highest point of the ACURATE neo or surgical valve) was determined. Ostia located below the highest plan were further subclassified according to the gap available between the transcatheter heart valve frame and ostium (transcatheter-to-coronary [TTC] distance). The impact implantation depth has on these geometrical relationships was evaluated.Results: A total of 21 out of 36 coronary ostia (58%) were located below the level of the HP with the left coronary artery (36%) more likely to be affected than the right (22%). Further sub-classification of these ostia revealed a large (>6 mm), moderate (4-6 mm), and small (<4 mm) TTC distance in 57% (12/21), 38% (8/21), and in 6%(1/18) of cases, respectively. At an implantation depth <4 mm compared to >4 mm, all ostia were located below the HP with no difference in post-procedural mean gra-

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Section: Impact Of Transcatheter Heart Valve Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Computed tomography analysis of coronary ostia location following valve‐in‐valve transcatheter aortic valve replacement with the ACURATE neo valve: Implications for coronary access

Khokhar

Laricchia

Ponticelli

et al. 2021

Cathet Cardio Intervent

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“…Low coronary ostia (defined as originating ≤ 10 mm above the aortic annulus) or the need for future percutaneous coronary interventions favor the use of THVs with a low stent frame and/or intra-annular leaflets, thereby minimizing potential interference with future coronary access (35).…”

Section: Aortic Valve and Aortic Rootmentioning

confidence: 99%

Patient-Tailored Aortic Valve Replacement

Wong

Wilkins

Carranza

et al. 2021

Front. Cardiovasc. Med.

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Contemporary surgical and transcatheter aortic valve interventions offer effective therapy for a broad range of patients with severe symptomatic aortic valve disease. Both approaches have seen significant advances in recent years. Guidelines have previously emphasized ‘surgical risk’ in the decision between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR), although this delineation becomes increasingly obsolete with more evidence on the effectiveness of TAVR in low surgical risk candidates. More importantly, decisions in tailoring aortic valve interventions should be patient-centered, accounting not only for operative risk, but also anatomy, lifetime management and specific co-morbidities. Aspects to be considered in a patient-tailored aortic valve intervention are discussed in this article.

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“…Secondly, the TAVI device's risk of obstructing coronary ostia is increasingly recognized. Ochiai et al reported the incidence of unfavorable coronary access identified by CT as being 16% and 35% to left coronary and 8%, 26% to right coronary following SAPIEN 3 or Evolute R/PRO respectively [106]. The successful rate of actual coronary catheterization was as low as 33% and 0% compared with 91% and 78% of those without CT evidence of unfavorable access.…”

Section: Is Tavi Ready For the Prime Time In Low Risk And Younger As mentioning

confidence: 99%

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement

Jin

Petrou

et al. 2021

Front. Med.

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Over the last half century, surgical aortic valve replacement (SAVR) has evolved to offer a durable and efficient valve haemodynamically, with low procedural complications that allows favourable remodelling of left ventricular (LV) structure and function. The latter has become more challenging among elderly patients, particularly following trans-catheter aortic valve implantation (TAVI). Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss, valvular-vascular impedance to myocardial activation, force-velocity relationship, and myocardial strain. LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour. Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome. Physiological pacing via the His-Purkinje system for conduction abnormalities, further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression, LV coordinate contraction, and global vascular function. TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions. Until comparable long-term durability and the resolution of TAVI related complications become available, SAVR remains the first choice for lower risk younger patients.

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Coronary Access After TAVR

Cited by 121 publications

References 21 publications

Computed tomography analysis of coronary ostia location following valve‐in‐valve transcatheter aortic valve replacement with the ACURATE neo valve: Implications for coronary access

Computed tomography analysis of coronary ostia location following valve‐in‐valve transcatheter aortic valve replacement with the ACURATE neo valve: Implications for coronary access

Patient-Tailored Aortic Valve Replacement

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement

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