CRT-700.41 Balloon-Expandable Valve for Treatment of Evolut Valve Failure: Implications on Neo-Skirt Height and Leaflet Overhang

Akodad, Mariama; Sellers, Stephanie; Landes, Uri; Meier, David; Gada, Hemal; Rogers, Toby; Caskey, Michael; Rutkin, Bruce; Puri, Rishi; Rovin, Joshua D.; Leipsic, Jonathon; Søndergaard, Lars; Grubb, Kendra J.; Gleason, Patrick; Garde, Kshitija; Tadros, Hatem; Teodoru, Sebastian; Wood, David; Webb, John G.; Sathananthan, Janarthanan

doi:10.1016/j.jcin.2022.01.248

Cited by 17 publications

(44 citation statements)

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“…However, as demonstrated in the ALIGN-ACCESS (TAVR with Commissural Alignment Followed by Coronary Access) study, the CA of supra-annular THVs, which can be achieved with the Evolut platforms, improves the feasibility of selective coronary access ( 7 ). Challenging coronary access might be even more frequent in valve-in-valve and redo-TAVR procedures, especially in the case of commissural misalignment and initial high implant of the initial THV, increasing the neo-skirt height ( 6 , 19 , 20 ).…”

Section: Clinical Impact Of Commissural Misalignmentmentioning

confidence: 99%

Transcatheter heart valve commissural alignment: an updated review

Akodad

Lounes

Meier

et al. 2023

Front. Cardiovasc. Med.

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Transcatheter aortic valve replacement (TAVR) indications recently extended to lower surgical risk patients with longer life expectancy. Commissural alignment (CA) is one of the emerging concepts and is becoming one of the cornerstones of the TAVR procedure in a patient with increased longevity. Indeed, CA may improve transcatheter heart valve (THV) hemodynamics, future coronary access, and repeatability. The definition of CA has been recently standardized by the ALIGN-TAVR consortium using a four-tier scale based on CT analysis. Progress has been made during the index TAVR procedure to optimize CA, especially with self-expandable platforms. Indeed, specific delivery catheter orientation, THV rotation, and computed-tomography-derived views have been proposed to achieve a reasonable degree of CA. Recent data demonstrate feasibility, safety, and a significant reduction in coronary overlap using these techniques, especially with self-expandable platforms. This review provides an overview of THV CA including assessment methods, alignment techniques during the index TAVR procedure with different THV platforms, the clinical impact of commissural misalignment, and challenging situations for CA.

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Section: Clinical Impact Of Commissural Misalignmentmentioning

confidence: 99%

Transcatheter heart valve commissural alignment: an updated review

Akodad

Lounes

Meier

et al. 2023

Front. Cardiovasc. Med.

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“…Consequently, CT scan is an important tool in the decision-making process of lifetime management of AS indicating (1) feasibility of future TAVR-in-TAVR and (2) which THV (SE or BE) might be preferred according the anatomic characteristics. 92 A secondary issue to be considered is the risk of severe PPM: it may occur in >30% of patients undergoing TAVR-in-TAVR although its effects on 1 year survival are still to be clarified. 93 Therefore, the risks related to TAVR explant and the possible complications related to TAVR-in-TAVR represent important issues to consider before selecting TAVR as first therapy.…”

Section: Tavr As First Therapymentioning

confidence: 99%

Lifetime Management of Aortic Stenosis: Transcatheter Versus Surgical Treatment for Young and Low-Risk Patients

Russo

Sangiorgi

Pedicino

et al. 2022

Circ: Cardiovascular Interventions

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Transcatheter aortic valve replacement is now indicated across all risk categories of patients with symptomatic severe aortic stenosis and has been proposed as first line option for the majority of patients >74 years old. However, median age of patients enrolled in the transcatheter aortic valve replacement low-risk trials is 74 years and transcatheter aortic valve replacement has never been systematically investigated in young low risk patients. Although the long-term data in surgical aortic valve replacement in young patients (age <75) are well known, such data remain lacking in transcatheter aortic valve replacement. In the absence of clear guideline recommendations in patients with challenging anatomies (eg, hostile calcium, bicuspid), it is important to know the potential advantages and disadvantages of each treatment and to consider how they might integrate with each other in the lifetime management of such patients. In this review, we discuss current outstanding issues on the management of severe aortic stenosis from a lifetime management perspective, particularly in terms of initial intervention and future reinterventions.

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“…Due to the long TAVR leaflets, especially in supra‐annular valves, there is a risk of sinus sequestration with leaflet tissue extending to the STJ or aorta. The valve to STJ (VTSJT) and valve to aorta (VTA) are also measured in redo‐TAVR preplanning and a distance of 2 mm is necessary 45 …”

Section: Expanding Utility Of Tavr Ctmentioning

confidence: 99%

“…The valve to STJ (VTSJT) and valve to aorta (VTA) are also measured in redo-TAVR preplanning and a distance of 2 mm is necessary. 45 Preprocedural planning for other valvular interventions is increasingly benefiting from TAVR CT analysis. Moreover, the Heart Team will evaluate each patient's anatomy based on the TAVR CT to determine the most appropriate treatment for the specific patient.…”

Section: Planning For Subsequent Valvesmentioning

confidence: 99%

Evolving computed tomography angiography for aortic valve replacement: Optimizing transcatheter and surgical therapies

Tully

Tom

Xie

et al. 2022

Journal of Cardiac Surgery

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Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and pre‐procedure planning relies heavily on advanced imaging. Multidetector computed tomography angiography, the “TAVR CT,” facilitates essential planning steps of measuring the aortic root for valve sizing and feasibility and assessment of potential access vessels, making it the guideline gold standard in preprocedural TAVR work up. This Impact of Advanced Imaging Techniques on Cardiac Surgery article will examine the development of TAVR CT, illustrate the current impact and utility, and highlight potential areas of future growth. Clinicians who keep informed of these changes and can become proficient with TAVR CT analyses will offer patients the most optimal results and fuel future therapeutic growth.

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CRT-700.41 Balloon-Expandable Valve for Treatment of Evolut Valve Failure: Implications on Neo-Skirt Height and Leaflet Overhang

Cited by 17 publications

References 0 publications

Transcatheter heart valve commissural alignment: an updated review

Transcatheter heart valve commissural alignment: an updated review

Lifetime Management of Aortic Stenosis: Transcatheter Versus Surgical Treatment for Young and Low-Risk Patients

Evolving computed tomography angiography for aortic valve replacement: Optimizing transcatheter and surgical therapies

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