Feasibility of selective coronary angiography and percutaneous coronary intervention following self-expanding transcatheter aortic valve replacement: a systematic review and meta-analysis

Gin, J.; Castles, A. Vlachadis; Koshy, A.; Yudi, M.

doi:10.1097/mca.0000000000001182

Cited by 1 publication

(1 citation statement)

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“…It is widely acknowledged that intra-annular THVs such as S3 and Navitor (Abbott Structural Heart) enable easier coronary access than the supra-annular THV such as Evolut (Medtronic). 13,22,23 However, ensuring coronary access even when 2 intra-annular THVs are in place remains challenging due to the unpredictability of aligning the 2 THV frames to optimize cell openings. 14 Ideally, catheter engagement for selective angiography should be uncomplicated when the top of the THV frame lies below the coronary ostia.…”

Section: Discussionmentioning

confidence: 99%

Redo-TAVR Feasibility After SAPIEN 3 Stratified by Implant Depth and Commissural Alignment: A CT Simulation Study

Koshy,

Tang,

Khera

et al. 2024

Circ: Cardiovascular Interventions

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BACKGROUND: Redo-transcatheter aortic valve replacement (TAVR) can pin the index transcatheter heart valve leaflets open leading to sinus sequestration and restricting coronary access. The impact of initial implant depth and commissural alignment on redo-TAVR feasibility is unclear. We sought to determine the feasibility of redo-TAVR and coronary access after SAPIEN 3 (S3) TAVR stratified by implant depth and commissural alignment. METHODS: Consecutive patients with native valve aortic stenosis were evaluated using multidetector computed tomography. S3 TAVR simulations were done at 3 implant depths, sizing per manufacturer recommendation and assuming nominal expansion in all cases. Redo-TAVR was deemed unfeasible based on valve-to-sinotubular junction distance and valve-to-sinus height <2 mm, while the neoskirt plane of the S3 transcatheter heart valve estimated coronary access feasibility. RESULTS: Overall, 1900 patients (mean age, 80.2±8 years; STS-PROM [Society of Thoracic Surgeons Predicted Risk of Operative Mortality], 3.4%) were included. Redo-TAVR feasibility reduced significantly at shallower initial S3 implant depths (2.3% at 80:20 versus 27.5% at 100:0, P <0.001). Larger S3 sizes reduced redo-TAVR feasibility, but only in patients with a 100:0 implant ( P <0.001). Commissural alignment would render redo-TAVR feasible in all patients, assuming the utilization of leaflet modification techniques to reduce the neoskirt height. Coronary access following TAV-in-TAV was affected by both index S3 implant depth and size. CONCLUSIONS: This study highlights the critical impact of implant depth, commissural alignment, and transcatheter heart valve size in predicting redo-TAVR feasibility. These findings highlight the necessity for individualized preprocedural planning, considering both immediate results and long-term prospects for reintervention as TAVR is increasingly utilized in younger patients with aortic stenosis.

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