Coronary Access After TAVR-in-TAVR as Evaluated by Multidetector Computed Tomography
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Coronary Access After TAVR-in-TAVR as Evaluated by Multidetector Computed Tomography. / De Backer, Ole; Landes, Uri; Fuchs, Andreas; Yoon, Sung Han; Mathiassen, Ole Norling; Sedaghat, Alexander; Kim, Won Keun; Pilgrim, Thomas; Buzzatti, Nicola; Ruile, Philipp; El Sabbagh, Abdallah; Barbanti, Marco; Fiorina, Claudia; Nombela-Franco, Luis; Steinvil, Arie; Finkelstein, Ariel; Montorfano, Matteo; Maurovich-Horvat, Pal; Kofoed, Klaus Fuglsang; Blanke, Philipp; Bunc, Matjaz; Neumann, Franz Josef; Latib, Azeem; Windecker, Stephan; Sinning, Jan Malte; Norgaard, Bjarne Linde; Makkar, Raj; Webb, John G.; Søndergaard, Lars.
I: JACC: Cardiovascular Interventions, Bind 13, Nr. 21, 2020, s. 2528-2538.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Coronary Access After TAVR-in-TAVR as Evaluated by Multidetector Computed Tomography
AU - De Backer, Ole
AU - Landes, Uri
AU - Fuchs, Andreas
AU - Yoon, Sung Han
AU - Mathiassen, Ole Norling
AU - Sedaghat, Alexander
AU - Kim, Won Keun
AU - Pilgrim, Thomas
AU - Buzzatti, Nicola
AU - Ruile, Philipp
AU - El Sabbagh, Abdallah
AU - Barbanti, Marco
AU - Fiorina, Claudia
AU - Nombela-Franco, Luis
AU - Steinvil, Arie
AU - Finkelstein, Ariel
AU - Montorfano, Matteo
AU - Maurovich-Horvat, Pal
AU - Kofoed, Klaus Fuglsang
AU - Blanke, Philipp
AU - Bunc, Matjaz
AU - Neumann, Franz Josef
AU - Latib, Azeem
AU - Windecker, Stephan
AU - Sinning, Jan Malte
AU - Norgaard, Bjarne Linde
AU - Makkar, Raj
AU - Webb, John G.
AU - Søndergaard, Lars
PY - 2020
Y1 - 2020
N2 - Objectives: The aim of this study was to assess coronary accessibility after transcatheter aortic valve replacement (TAVR)–in–TAVR using multidetector computed tomography. Background: Expanding TAVR to patients with longer life expectancy may involve more frequent bioprosthetic valve failure and need for redo TAVR. Coronary access after TAVR-in-TAVR may be challenging, particularly as the leaflets from the initial transcatheter heart valve (THV) will form a neo-skirt following TAVR-in-TAVR. Methods: In 45 patients treated with different combinations of CoreValve and Evolut (CV/EV) THVs with supra-annular leaflet position and SAPIEN THVs with intra-annular leaflet position, post-TAVR-in-TAVR multidetector computed tomographic scans were analyzed to examine coronary accessibility. Results: After TAVR-in-TAVR, the coronary arteries originated below the top of the neo-skirt in 90% of CV/EV-first cases compared with 67% of SAPIEN-first cases (p = 0.009). For these coronary arteries originating below the top of the neo-skirt, the distance between the THV and the aortic wall was <3 mm in 56% and 25% of CV/EV-first and SAPIEN-first cases, respectively (p = 0.035). Coronary access may be further complicated by THV-THV stent frame strut misalignment in 53% of CV/EV-in-CV/EV cases. The risk for technically impossible coronary access was 27% and 10% in CV/EV-first and SAPIEN-first cases, respectively (p = 0.121). Absence of THV interference with coronary accessibility can be expected in 8% and 33% of CV/EV-first and SAPIEN-first cases, respectively (p = 0.005). Conclusions: Coronary access after TAVR-in-TAVR may be challenging in a significant proportion of patients. THVs with intra-annular leaflet position or low commissural height and large open cells may be preferable in terms of coronary access after TAVR-in-TAVR.
AB - Objectives: The aim of this study was to assess coronary accessibility after transcatheter aortic valve replacement (TAVR)–in–TAVR using multidetector computed tomography. Background: Expanding TAVR to patients with longer life expectancy may involve more frequent bioprosthetic valve failure and need for redo TAVR. Coronary access after TAVR-in-TAVR may be challenging, particularly as the leaflets from the initial transcatheter heart valve (THV) will form a neo-skirt following TAVR-in-TAVR. Methods: In 45 patients treated with different combinations of CoreValve and Evolut (CV/EV) THVs with supra-annular leaflet position and SAPIEN THVs with intra-annular leaflet position, post-TAVR-in-TAVR multidetector computed tomographic scans were analyzed to examine coronary accessibility. Results: After TAVR-in-TAVR, the coronary arteries originated below the top of the neo-skirt in 90% of CV/EV-first cases compared with 67% of SAPIEN-first cases (p = 0.009). For these coronary arteries originating below the top of the neo-skirt, the distance between the THV and the aortic wall was <3 mm in 56% and 25% of CV/EV-first and SAPIEN-first cases, respectively (p = 0.035). Coronary access may be further complicated by THV-THV stent frame strut misalignment in 53% of CV/EV-in-CV/EV cases. The risk for technically impossible coronary access was 27% and 10% in CV/EV-first and SAPIEN-first cases, respectively (p = 0.121). Absence of THV interference with coronary accessibility can be expected in 8% and 33% of CV/EV-first and SAPIEN-first cases, respectively (p = 0.005). Conclusions: Coronary access after TAVR-in-TAVR may be challenging in a significant proportion of patients. THVs with intra-annular leaflet position or low commissural height and large open cells may be preferable in terms of coronary access after TAVR-in-TAVR.
KW - computed tomography
KW - coronary access
KW - transcatheter aortic valve
U2 - 10.1016/j.jcin.2020.06.016
DO - 10.1016/j.jcin.2020.06.016
M3 - Journal article
C2 - 33153567
AN - SCOPUS:85094322318
VL - 13
SP - 2528
EP - 2538
JO - J A C C: Cardiovascular Interventions
JF - J A C C: Cardiovascular Interventions
SN - 1936-8798
IS - 21
ER -
ID: 260598035