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Interaction Between Self-Expanding Transcatheter Heart Valves and Coronary Ostia: An Angiographically Based Analysis

Thomas Couture, Laurent Faroux, Lucia Junquera

  • 1Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, G1V4G5, Quebec City, Quebec, Canada. josep.rodes@criucpq.ulaval.ca.

The Journal of Invasive Cardiology
|March 12, 2020
PubMed

Insights

The Evolut R/Pro valve is usually placed below the left coronary artery ostium. Shallower implantation (≤6mm) increases the risk of the valve being at or above the coronary ostia, potentially impacting future coronary access.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
  • Accurate positioning of the replacement valve is crucial to avoid complications.
  • The CoreValve Evolut R/Pro (Medtronic) is a widely used TAVR prosthesis.

Purpose of the Study:

  • To assess the positioning of the Evolut R/Pro valve relative to the left coronary artery (LCA) ostium.
  • To evaluate how implantation depth affects the valve's relationship with the LCA ostium.

Main Methods:

  • One hundred patients receiving an Evolut R/Pro valve underwent post-implantation angiography.
  • Measurements included valve implantation depth and position relative to the LCA ostium.
  • Coronary access issues post-TAVR were recorded.

Main Results:

  • The Evolut R/Pro neo-valve was infraostial in 85% of cases.
  • Implantation depth ≤6 mm was linked to a higher rate of supraostial or at-ostial positioning (25% vs 4%, P=.01).
  • Coronary artery access was needed in 10% of patients at follow-up.

Conclusions:

  • The Evolut R/Pro valve is predominantly positioned below the LCA ostium.
  • Shallower implantation depths (≤6 mm) increase the likelihood of the neo-valve being at or above the coronary ostia.
  • Further research is needed to understand the impact of high valve positioning on post-TAVR coronary access.
Abstract

Keywords:
coronary angiogrampercutaneous coronary interventiontranscatheter aortic valve replacement

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