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Risk of Coronary Obstruction Due to Sinus Sequestration in Redo Transcatheter Aortic Valve Replacement

Tomoki Ochiai1, Luke Oakley2, Navjot Sekhon2

  • 1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.

JACC. Cardiovascular Interventions
|November 20, 2020
PubMed

Insights

Redo transcatheter aortic valve replacement (TAVR) with Evolut valves poses a higher risk of coronary obstruction from sinus sequestration compared to SAPIEN 3 valves. Careful CT screening is crucial, especially with low sinotubular junction height, to mitigate risks in future redo TAVR procedures.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Coronary obstruction due to sinus sequestration is a potential complication in redo transcatheter aortic valve replacement (TAVR).
  • Limited data exists on the specific risks associated with different TAV prostheses in redo TAVR procedures.

Purpose of the Study:

  • To evaluate the risk of coronary obstruction from sinus sequestration in patients undergoing redo TAVR.
  • To compare this risk between Evolut R/PRO and SAPIEN 3 valve types using post-procedural computed tomography (CT).

Main Methods:

  • Analysis of post-TAVR CT scans from 66 patients with Evolut R/PRO and 345 patients with SAPIEN 3 valves.
  • Definition of sinus sequestration risk based on prior TAV commissure level relative to the sinotubular junction (STJ) and distance between TAV and STJ.

Main Results:

  • A significantly higher CT-identified risk of sinus sequestration was observed in the Evolut R/PRO group (45.5%) compared to the SAPIEN 3 group (2.0%) (p < 0.001).
  • Specific risks for left and right coronary arteries were higher with Evolut valves (39.4% and 24.2%, respectively) versus SAPIEN 3 (2.0% and 0.6%).
  • Overlaps between prior TAV commissural posts and coronary ostia were more frequent in the Evolut group (45.2%) than the SAPIEN 3 group (11.1%) among at-risk coronary arteries.

Conclusions:

  • The risk of sinus sequestration in redo TAVR necessitates careful CT screening, particularly in patients with low STJ height.
  • TAVs designed for commissure-to-commissure alignment with native valves may reduce the risk of coronary obstruction and facilitate future leaflet laceration procedures.
Abstract

Keywords:
BASILICAcoronary obstructiondurabilitytranscatheter aortic valve replacementvalve-in-valve

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