Related Experiment Video
Updated: Jun 15, 2025
Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
Published on: June 8, 2022
Coronary Access and PCI after Transcatheter Aortic Valve Replacement With Different Self-Expanding Platforms in
Francesco Giannini1, Arif A Khokhar2, Jonathan Curio3
1Interventional Cardiology Unit, IRCCS Galeazzi Sant'Ambrogio Hospital, Milan, Italy.
Insights
Coronary access and PCI after valve-in-valve TAVR were more successful with ACURATE neo2 compared to Evolut PRO+. Valve design significantly impacts procedural outcomes and cannulation techniques in these complex cases.
Area of Science:
- Cardiovascular Interventions
- Medical Device Technology
- Interventional Cardiology
Background:
- Coronary access (CA) and percutaneous coronary intervention (PCI) can be challenging post-valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) using supra-annular self-expanding valves (SS-TAVs) in surgical aortic valves (SAVs).
- Comparing the feasibility and techniques of CA and PCI is crucial for optimizing patient outcomes after ViV-TAVR.
Purpose of the Study:
- To compare the feasibility, predictors, and techniques of coronary access (CA) and percutaneous coronary intervention (PCI) following ViV-TAVR.
- To evaluate the performance of ACURATE neo2 versus Evolut PRO+ SS-TAVs in facilitating CA and PCI.
Main Methods:
- Utilized 15 patient-specific 3D-printed aortic models with implanted SAVs and two SS-TAVs (ACURATE neo2 and Evolut PRO+).
- Two operators performed simulated CA and PCI (n=120 each) in a pulsatile flow simulator under realistic conditions.
- Assessed procedural success rates, procedural time, and utilized an borescope camera and CT imaging for analysis.
Main Results:
- ACURATE neo2 demonstrated significantly higher successful CA (96.7% vs 75%) and PCI (98.3% vs 85%) rates compared to Evolut PRO+.
- Smaller SAV size and Evolut PRO+ were independent predictors of unsuccessful CA and PCI.
- ACURATE neo2's advantage was linked to a greater valve-to-anatomy distance, facilitating external cannulation more frequently.
Conclusions:
- Successful coronary access and PCI rates were higher with the ACURATE neo2 compared to the Evolut PRO+ in the ViV-TAVR setting.
- The design differences between SS-TAVs influence cannulation approaches and subsequent procedural success rates.
Background:
Coronary access (CA) and percutaneous coronary intervention (PCI) might be challenging after valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) with supra-annular self-expanding valves (SS-TAVs) in surgical aortic valves (SAVs). Our study aim was to compare feasibility, predictors, and techniques of CA and PCI following ViV-TAVR with ACURATE neo2 (Boston Scientific, Marlborough, MA) and Evolut PRO+ (Medtronic, Minneapolis, MN).
Methods:
Fifteen computed tomography (CT)-based patient-specific aortic models were 3-dimensionally (3D) printed and implanted with specific SAVs and with the 2 SS-TAVs with commissural alignment. Two operators attempted CA (n = 120) and PCI (n = 120) of each coronary artery in a pulsatile-flow-simulator, under real catheterization laboratory conditions. The primary endpoints were the rate of successful CA and PCI. Outcomes with different SS-TAVs were directly compared. An internally mounted borescope camera was used to assess procedures. CT of the models was obtained.
Results:
ACURATE neo2 showed significantly higher rates of successful CA (96.7% vs 75%, P = 0.001) and PCI (98.3% vs 85%, P = 0.008) and was associated with a shorter procedural time compared with Evolut PRO+. Independent predictors of unsuccessful CA and PCI were smaller SAV size and Evolut PRO+. The advantage of ACURATE neo2 was mediated by a larger valve-to-anatomy distance at the top of the leaflet plane (11.3 mm vs 4.8 mm), facilitating more often an external cannulation approach for both CA (36.7% vs 15%, P < 0.001) and PCI (36.7% vs 21.7%, P = 0.013).
Conclusions:
The rate of successful CA and PCI following ViV-TAVR was higher with ACURATE neo2 compared with Evolut PRO+. The differences in SS-TAVs design affected the cannulation approach and subsequent procedural outcomes.
