Transcatheter aortic valve replacement aortic root orientation: implications for future coronary access and redo transcatheter aortic valve replacement

Alexis, Sophia L.; Zaid, Syed; Sengupta, Aditya; Khera, Sahil; Sharma, Samin K.; Kini, Annapoorna

doi:10.21037/acs-2020-av-10

Cited by 6 publications

(2 citation statements)

References 11 publications

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“…It was found that more than 30%–50% of cases of TAVR had an overlap with one or both coronary arteries 39 . It was reported that commissural misalignment may lead to variable degrees of overlap between the neo‐commissural posts and coronary arteries leading to a disruption of the CF 39–42 . Also, computational studies have shown that commissural alignment minimized the effect of TAVR stent distortion on peak stresses in the TAVR leaflets 43 .…”

Section: Discussionmentioning

confidence: 99%

Impact of blood pressure on coronary perfusion and valvular hemodynamics after aortic valve replacement

Vogl

Darestani

Lilly

et al. 2021

Cathet Cardio Intervent

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Objective: Our objective was to evaluate the impact of various blood pressures (BPs) on coronary perfusion and valvular hemodynamics following aortic valve replacement (AVR).Background: Lower systolic and diastolic (SBP/DBP) pressures from the recommended optimal target range of SBP < 120-130 mmHg and DBP < 80 mmHg after AVR have been independently associated with increased cardiovascular and all-cause mortality. Methods:The hemodynamic assessment of a 26 mm SAPIEN 3 transcatheter aortic valve (TAV), 29 mm Evolut R TAV, and 25 mm Magna Ease surgical aortic valve (SAV) was performed in a pulsed left heart simulator with varying SBP, DBP, and heart rate (HR) conditions (60 and 120 bpm) at 5 L/min cardiac output (CO). Average coronary flow (CF), effective orifice areas (EOAs), and valvulo-arterial impedance (Zva) were calculated.Results: At HR of 60 bpm, at SBP < 120 mmHg and DBP < 60 mmHg, CF decreased below the physiological lower limit with several different valves. Zva and EOA were found to increase and decrease respectively with increasing SBP and DBP. The same results were found with an HR of 120 bpm. The trends of CF variation with BP were similar in all valves however the drop below the lower physiological CF limit was valve dependent. Conclusion:In a controlled in vitro system, with different aortic valve prostheses in place, CF decreased below the physiologic minimum when SBP and DBP were in the range targeted by blood pressure guidelines. Combined with recent observations from patients treated with AVR, these findings underscore the need for additional studies to identify the optimal BP in patients treated with AVR for AS.

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Section: Discussionmentioning

confidence: 99%

Impact of blood pressure on coronary perfusion and valvular hemodynamics after aortic valve replacement

Vogl

Darestani

Lilly

et al. 2021

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…We can then superimpose a virtual image of either the SAPIEN 3 THV (Edwards Lifesciences LLC, Irvine, CA, USA) or the Evolut THV (Medtronic Inc., Minneapolis, MN, USA) over the axial MDCT annular and sinus of Valsalva images derived from the 3Mensio Valves software. This allows us to determine the degree of overlap between the neo-commissures and the coronary ostia [ 11 ] . Note that the use of various third-party software systems introduces the risk of operator bias that has to be taken into consideration when performing the aforementioned analyses.…”

Section: Imaging-based Assessment Of Thv Orientationmentioning

confidence: 99%

Current challenges in TAVI: neo-commissural alignment to mimic more physiologic valve implantation

Sengupta

Alexis

Kovacic

2020

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Commissural alignment during transcatheter aortic valve implantation (TAVI) has important clinical implications as TAVI expands to younger patients in whom lifetime treatment of aortic valve disease and coronary artery disease is of particular importance. Numerous studies have shown that lack of commissural alignment may adversely affect coronary reaccess and the feasibility of redo-TAVI in this patient population. To assess the risk of commissural misalignment more accurately, we have pioneered and validated the use of a preprocedural imaging protocol that determines valve orientation using multi-detector computed tomography-fluoroscopy co-registration. Furthermore, we have shown that a modified delivery system insertion technique during initial valve deployment results in improved commissural alignment and reduced coronary artery overlap following TAVI with a self-expanding device. However, numerous unanswered questions remain about the impact of commissural misalignment on balloon-expandable valve-in-valve TAVI, especially in patients with unfavorable aortic root anatomy. It is imperative that clinicians consider these anatomic, device-related, and procedure factors, among others, when evaluating patients for transcatheter therapies.

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Cusp Overlap Technique: Should It Become the Standard Implantation Technique for Self-expanding Valves?

et al. 2021

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Transcatheter aortic valve replacement aortic root orientation: implications for future coronary access and redo transcatheter aortic valve replacement

Cited by 6 publications

References 11 publications

Impact of blood pressure on coronary perfusion and valvular hemodynamics after aortic valve replacement

Impact of blood pressure on coronary perfusion and valvular hemodynamics after aortic valve replacement

Current challenges in TAVI: neo-commissural alignment to mimic more physiologic valve implantation

Cusp Overlap Technique: Should It Become the Standard Implantation Technique for Self-expanding Valves?

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