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Published on: December 11, 2017
Risk of Coronary Obstruction in Redo-Transcatheter Aortic Valve Replacement Between Bicuspid and Tricuspid Aortic
Atsushi Okada1, Syed Zaid2, Miho Fukui3
1Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Background:
Transcatheter aortic valve replacement (TAVR) is approved across all risk profiles, including patients with bicuspid aortic valves. These patients are generally younger, with a higher chance of reintervention.
Objectives:
The aim of this study was to compare the feasibility of redo transcatheter aortic valve (TAV) between bicuspid and tricuspid aortic valves.
Methods:
A computed tomographic (CT) simulation of redo-TAV was conducted using 913 post-TAVR CT studies from patients who underwent TAVR with SAPIEN 3 or SAPIEN 3 Ultra (S3; n = 623) or Evolut R, Evolut PRO, or Evolut PRO+ (Evolut; n = 290) valves. Fifty-nine cases were for bicuspid valves. Four redo-TAV scenarios-S3-in-S3, Evolut-in-S3, S3-in-Evolut, and Evolut-in-Evolut-were simulated. Second TAV size was determined from the averaged stent areas in the landing zone, except for Evolut-in-Evolut, for which same size was simulated. Redo-TAV feasibility (risk to coronary arteries) was estimated by the relationship between neoskirt plane and coronary risk plane or sinotubular junction and the narrowest valve-to-aorta distances.
Results:
Patients with bicuspid valves, compared with those with tricuspid valves, were younger with lower surgical risk and had larger annular areas (522 mm2 [Q1-Q3: 461-597 mm2] vs 479 mm2 [Q1-Q3: 416-551 mm2]), sinus of Valsalva diameters (34 mm [Q1-Q3: 31-36 mm] vs 32 mm [Q1-Q3: 30-35 mm]), and sinotubular junction diameters (30 mm [Q1-Q3: 28-33 mm] vs 29 mm [Q1-Q3: 27-31 mm]) (P < 0.05 for all). Narrowest valve-to-aorta distances were longer in bicuspid cases, resulting in higher redo-TAV feasibility for S3-in-S3 and Evolut-in-S3 scenarios. Similar trends were observed for S3-in-Evolut and Evolut-in-Evolut, for which the feasibility tended to be higher in bicuspid cases.
Conclusions:
Redo-TAV simulation using post-TAVR CT imaging performed at 30 days suggested higher redo-TAV feasibility in patients with bicuspid aortic valves compared with tricuspid aortic valves.
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