Risk of Coronary Obstruction and Feasibility of Coronary Access After Repeat Transcatheter Aortic Valve Replacement With the Self-Expanding Evolut Valve

DOI Web Site 被引用文献1件
  • Brian J. Forrestal
    Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.
  • Brian C. Case
    Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.
  • Charan Yerasi
    Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.
  • Corey Shea
    Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.
  • Rebecca Torguson
    Department of Cardiovascular Research and Clinical Trials, Mount Sinai School of Medicine, New York, NY (R.T.).
  • Cheng Zhang
    Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.
  • Itsik Ben-Dor
    Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.
  • Teshome Deksissa
    Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.
  • Syed Ali
    Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.
  • Lowell F. Satler
    Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.
  • Christian Shults
  • Gaby Weissman
    Section of Cardiovascular Imaging (G.W.), MedStar Washington Hospital Center, Washington, DC.
  • John C. Wang
    Section of Interventional Cardiology, MedStar Union Memorial Hospital, Baltimore, MD (J.C.W.).
  • Jaffar M. Khan
    Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., T.R.).
  • Ron Waksman
    Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.
  • Toby Rogers
    Section of Interventional Cardiology (B.J.F., B.C.C., C.Y., C.S., C.Z., I.B.-D., T.D., S.A., L.F.S., J.M.K., R.W., T.R.), MedStar Washington Hospital Center, Washington, DC.

書誌事項

タイトル別名
  • A Computed Tomography Simulation Study

抄録

<jats:sec> <jats:title>Background:</jats:title> <jats:p>The supra-annular leaflet position and tall stent frame of the self-expanding Evolut PRO or Evolut PRO+ transcatheter heart valves (THVs) may cause coronary occlusion during transcatheter aortic valve replacement (TAVR)-in-TAVR and present challenges for future coronary access. We sought to evaluate the risk of TAVR-in-TAVR with Evolut PRO or Evolut PRO+ THVs and the feasibility of future coronary access.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>The CoreValve Evolut PRO Prospective Registry (EPROMPT; NCT03423459) prospectively enrolled patients with symptomatic severe aortic stenosis to undergo TAVR using a commercially available latest generation self-expanding THV at 2 centers in the United States. Computed tomography was performed 30 days after TAVR, which we used to simulate TAVR-in-TAVR with a second Evolut PRO or Evolut PRO+ THV and evaluate for risk of coronary obstruction and feasibility of future coronary access.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Eighty-one patients enrolled with interpretable computed tomography are reported herein. Computed tomography simulation predicted sinus of Valsalva sequestration and resultant coronary obstruction during future TAVR-in-TAVR in up to 23% of patients. Computed tomography simulation predicted that the position of the pinned THV leaflets would hinder future coronary access in up to 78% of patients after TAVR-in-TAVR.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Further THV design improvements and leaflet modification strategies are needed to mitigate the risk of coronary obstruction during TAVR-in-TAVR with self-expanding THVs and to facilitate future coronary access.</jats:p> </jats:sec> <jats:sec> <jats:title>Registration:</jats:title> <jats:p> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> . Unique identifier: NCT03423459. </jats:p> </jats:sec>

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