Redo-TAVR Feasibility After SAPIEN 3 Stratified by Implant Depth and Commissural Alignment: A CT Simulation Study

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomedical Engineering

Background:

• Redo-transcatheter aortic valve replacement (TAVR) can compromise coronary access due to leaflet sequestration.
• The influence of initial TAVR implant depth and commissural alignment on redo-TAVR feasibility remains unclear.

Purpose of the Study:

• To assess the feasibility of redo-TAVR and coronary access after SAPIEN 3 (S3) TAVR.
• To stratify feasibility based on initial implant depth and commissural alignment.

Main Methods:

• Utilized multidetector computed tomography for patient evaluation.
• Performed S3 TAVR simulations at varying implant depths.
• Assessed redo-TAVR unfeasibility using specific valve-to-sinotubular junction and sinus height criteria.
• Estimated coronary access feasibility based on the neoskirt plane.

Main Results:

• Redo-TAVR feasibility significantly decreased with shallower initial S3 implant depths (2.3% vs. 27.5%).
• Larger S3 valve sizes reduced redo-TAVR feasibility, particularly with 100:0 implants.
• Commissural alignment, with leaflet modification, could enable redo-TAVR in all cases.
• Coronary access was impacted by initial S3 implant depth and size.

Conclusions:

• Implant depth, commissural alignment, and valve size critically predict redo-TAVR feasibility.
• Individualized preprocedural planning is essential for long-term reintervention prospects.
• Consideration of future interventions is vital as TAVR use expands in younger populations.