Comparison of Leaflet Modification Techniques for TAV-in-TAV: Insights From Bench Testing

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Biomedical Engineering

Background:

• Transcatheter aortic valve (TAV) leaflet modification is crucial for mitigating coronary obstruction risks during TAV-in-TAV procedures.
• The neoskirt of the second TAV can obstruct coronary arteries.

Purpose of the Study:

• To compare leaflet splay geometry from different leaflet modification techniques.
• To evaluate these techniques across various TAV-in-TAV configurations.

Main Methods:

• Simulated BASILICA, balloon-assisted BASILICA (BA-BASILICA), and UNICORN on benchtop TAV-in-TAV models (short-in-tall, short-in-short, tall-in-short).
• Assessed leaflet splay area and functional splay area (FSA) using high-resolution imaging.
• Analyzed factors influencing FSA, including splay obstruction.

Main Results:

• BASILICA and BA-BASILICA produced similar V-shaped splays (19.2–64.9 mm²).
• UNICORN generated larger splays (2-10x) in short-in-tall and short-in-short configurations.
• Tall-in-short combinations showed up to 93% splay obstruction, minimizing FSA with BASILICA/BA-BASILICA.

Conclusions:

• BASILICA and BA-BASILICA yield comparable splays; UNICORN creates larger FSAs when feasible.
• Second TAV design, commissural alignment, and implantation depth significantly impact post-modification FSA.