Repeat transcatheter aortic valve implantation and implications for transcatheter heart valve performance: insights from bench testing

Sathananthan, Janarthanan; Fraser, Rob; Landes, Uri; Rich, Courtney; Sellers, Stephanie; Leipsic, Jonathon; Blanke, Philipp; Lutter, Georg; Frank, Derk; Puehler, Thomas; Wood, David; Søndergaard, Lars; Webb, John G.

doi:10.4244/eij-d-20-00697

Cited by 24 publications

(9 citation statements)

References 20 publications

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“…Patient-prosthesis mismatch after a second TAVI, although less relevant than TAVI for degenerated surgical aortic valves, needs to be also anticipated: for example, a supra-annular TAV should be considered as the preferred strategy in case of degenerated intraannular TAV, particularly in case of small anatomies. 5 An emerging issue of redo TAVI procedure is the creation of a double stent layer that interposes between the aortic valve and coronary arteries. This barrier can create an obstacle to coronary reaccess and might even sequestrate the blood flow within the sinuses of Valsalva.…”

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confidence: 99%

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Repeat Transcatheter Aortic Valve Implantation: All That Glitters Is Not Gold…Yet

Barbanti

Costa

2021

Circ: Cardiovascular Interventions

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Section: See Article By Testa Et Almentioning

confidence: 99%

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confidence: 99%

Repeat Transcatheter Aortic Valve Implantation: All That Glitters Is Not Gold…Yet

Barbanti

Costa

2021

Circ: Cardiovascular Interventions

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“…The TAV-in-TAV implantation technique has been subject to numerous studies. Initially, Sathananthan et al ( 31 ) assessed the performance of various THV models (SAPIEN 3, Evolut PRO, ACURATE neo, ALLEGRA, and Portico). Multiple THV implantation depths were tested and are summarized in Figure 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Lastly, the phenomenon of leaflets' pinwheeling, characterized by the twisting of the leaflet-free edges due to excessive leaflet redundancy, has been studied. Excessive pinwheeling was observed when implanting a Sapien 3 in a Sapien XT ( 31 ). This observation was recently confirmed by Meir et al ( 34 ) who investigated the expansion of TAV-in-TAV using a Sapien 3 (23 mm) in a Sapien XT/3 (23 mm).…”

Section: Introductionmentioning

confidence: 99%

Clinical considerations and challenges in TAV-in-TAV procedures

Hayek,

Prieur,

Dürrleman

et al. 2024

Front. Cardiovasc. Med.

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Transcatheter aortic valve replacement (TAVR) has emerged as a viable treatment for aortic valve disease, including low-risk patients. However, as TAVR usage increases, concerns about long-term durability and the potential for addition interventions have arisen. Transcatheter aortic valve (TAV)-in-TAV procedures have shown promise in selected patients in numerous registries, offering a less morbid alternative to TAVR explantation. In this review, the authors aimed to comprehensively review the experience surrounding TAV-in-TAV, summarize available data, discuss pre-procedural planning, highlight associated challenges, emphasize the importance of coronary obstruction assessment and provide insights into the future of this technique.

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“…coronary obstruction and affect the risk of patientprosthesis mismatch (PPM). Prior investigations, using benchtops, [6][7][8][9] have demonstrated sizing compatibilities between various TAVs, but these are based on a fully expanded index TAV. Most TAVs, however, are underexpanded in vivo, 10 and although in theory, they can be further expanded to nominal size, such further expansion may increase the risk of annular injury and coronary complications.…”

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confidence: 99%

Feasibility of Redo-Transcatheter Aortic Valve Replacement in Sapien Valves Based on In Vivo Computed Tomography Assessment

Fukui,

Okada,

Thao

et al. 2023

Circ: Cardiovascular Interventions

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BACKGROUND: Our aim was to assess the feasibility of repeat transcatheter aortic valve (TAV) replacement for degenerated Sapien3 (S3) prostheses by simulating subsequent implantation of S3 or Evolut, using in vivo computed tomography–based sizing and the impact on coronary and patient-prosthesis mismatch risks. METHODS: Computed tomography scans from 356 patients with prior S3 TAV replacement implantation were analyzed. The in vivo sizing for second TAV based on averaged area of 3 levels of outflow, mid (narrowest) and inflow, was compared with in vitro recommendations, that is, same size as index S3 for second S3 and 1 size larger for Evolut. Risks of coronary obstruction and patient-prosthesis mismatch were determined by valve-to-aorta distance and estimated effective orifice area, respectively. RESULTS: Overall, the majority of patients (n=328; 92.1%) had underexpanded index S3 with an expansion area of 94% (91%–97%), leading to significant differences in size selection of the second TAV between in vivo and in vitro sizing strategies. Expansion area <89% served as a threshold, resulting in 1 size smaller than the in vitro recommendations were selected in 45 patients (13%) for S3-in-S3 and 13 (4%) for Evolut-in-S3, while the remaining patients followed in vitro recommendations ( P <0.01, in vivo versus in vitro sizing). Overall, 57% of total patients for S3-in-S3 simulation and 60% for Evolut-in-S3 were considered low risk for coronary complications. Deep index S3 implantation (odds ratio, 0.76 [interquartile range, 0.67–0.87]; P <0.001) and selecting Evolut as the second TAV (11% risk reduction in intermediate- or high-risk patients) reduced coronary risk. Estimated moderate or severe patient-prosthesis mismatch risk was 21% for S3-in-S3 and 1% for Evolut-in-S3, assuming optimal expansion of the second TAV. CONCLUSIONS: Redo-TAV replacement with S3-in-S3 and Evolut-in-S3 could be feasible with low risk to coronaries in ≈60% of patients, while the remaining 40% will be at intermediate or high risk. The feasibility of redo-TAV replacement is influenced by sizing strategy, type of second TAV, native annular anatomy, and implant depth.

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Repeat transcatheter aortic valve implantation and implications for transcatheter heart valve performance: insights from bench testing

Cited by 24 publications

References 20 publications

Repeat Transcatheter Aortic Valve Implantation: All That Glitters Is Not Gold…Yet

Repeat Transcatheter Aortic Valve Implantation: All That Glitters Is Not Gold…Yet

Clinical considerations and challenges in TAV-in-TAV procedures

Feasibility of Redo-Transcatheter Aortic Valve Replacement in Sapien Valves Based on In Vivo Computed Tomography Assessment

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