Risk of Coronary Occlusion Due to Sinus Sequestration by Redo Transcatheter Aortic Valve Implantation in Japanese Patients With SAPIEN 3

Abstract

Background: Transcatheter aortic valve (TAV)-in-TAV is an attractive treatment for degenerated TAV. The risk of coronary artery occlusion due to sequestration of the sinus of Valsalva (SOV) in TAV-in-TAV has been reported, but the risk in Japanese patients is unknown. This study aimed to investigate the proportion of Japanese patients who are expected to experience difficulty with the second TAV implantation (TAVI) and evaluate the possibility of reducing the risk of coronary artery occlusion.Methods and Results: Patients (n=308) with an implanted SAPIEN 3 were divided into 2 groups: a high-risk group, which included patients with a TAV-sinotubular junction (STJ) distance <2 mm and a risk plane above the STJ (n=121); and a low-risk group, which included all other patients (n=187). The preoperative SOV diameter, mean STJ diameter, and STJ height were significantly larger in the low-risk group (P<0.05). The cut-off value for predicting the risk of SOV sequestration due to TAV-in-TAV in the difference between the mean STJ diameter and area-derived annulus diameter was 3.0 mm (sensitivity 70%; specificity 68%; area under the curve 0.74).Conclusions: Japanese patients may have a higher risk for sinus sequestration caused by TAV-in-TAV. The risk of sinus sequestration should be assessed before the first TAVI in young patients who are likely to require TAV-in-TAV, and whether TAVI is the best aortic valve therapy must be carefully decided.

Repeat Transcatheter Aortic Valve Implantation

“…These seemingly minor differences in measurement could have large clinical impacts. Second, compared with other similar reports in Asian populations, 11 , 12 , 14 , 15 the current analysis had a significantly older patient population with smaller reported body surface areas. Finally, the study spanned a relatively long duration time (2016 to 2022).…”

Delayed migration of a Sapien 3 Ultra Resilia following transcatheter aortic valve implantation after selection of a smaller-sized valve

“…The choice of S3UR size is particularly important in patients with a borderline S3UR size measured on preoperative CT of the aortic valve orifice area. There are some reports on selection of transcatheter heart valve (THV) size for a borderline-sized aortic annulus [ 6 , 7 ]; the options are to over-expand a smaller-sized THV or under-expand a larger-sized THV. There are some advantages if a smaller-sized THV is selected, including a lower risk of aortic root injury, which improves the potential feasibility of repeat TAVI in the future because of the low risk of sinus sequestration and left main coronary obstruction.…”