Name of journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of CardiologyAbstract: AIMS: We sought to predict how many TAVIs patients could undergo in their lifetime using computed tomography (CT) simulation.BACKGROUND: Given enough time, transcatheter heart valves (THVs) will degenerate and may require reintervention. Redo transcatheter aortic valve implantation (TAVI) is an attractive strategy but carries a risk of coronary obstruction.CLINICALTRIAL: gov: NCT02628899; ClinicalTrial.gov: NCT03557242; ClinicalTrial.gov: NCT03423459.CONCLUSIONS: Using cardiac CT simulation, it is possible to predict whether a patient can undergo multiple TAVI procedures in their lifetime. Those who cannot may prefer to undergo surgery first. CT simulation could provide a personalised lifetime management strategy for younger patients with symptomatic severe aortic stenosis and inform decision-making.METHODS: We analysed paired CT scans (baseline and 30 days post-TAVI) from patients in the LRT trials and EPROMPT registry. We implanted virtual THVs on baseline CTs, comparing predicted valve-to-coronary (VTC) distances to 30-day CT VTC distances to evaluate the accuracy of CT simulation. We then simulated implantation of a second virtual THV within the first to estimate the risk of coronary obstruction due to sinus sequestration and the need for leaflet modification.RESULTS: We included 213 patients with evaluable paired CTs. There was good agreement between virtual (baseline) and actual (30 days) CT measurements. CT simulation of TAVI followed by redo TAVI predicted low coronary obstruction risk in 25.4% of patients and high risk, likely necessitating leaflet modification, in 27.7%, regardless of THV type. The remaining 46.9% could undergo redo TAVI so long as the first THV was balloon-expandable but would likely require leaflet modification if the first THV was self-expanding.All authors: Ali SW, Asch FM, Ben-Dor I, Bilfinger T, Buchbinder M, Case BC, Ehsan A, Forrestal BJ, Garcia-Garcia HM, Gordon P, Hanna N, Levitt R, Medranda GA, Parikh P, Rogers T, Satler LF, Shea C, Shults CC, Soria Jimenez CE, Torguson R, Waksman R, Wang JC, Weissman G, Wilson SR, Zhang CFiscal year: FY2022 Digital Object Identifier:

https://dx.doi.org/10.4244/EIJ-D-21-01091

Date added to catalog: 2022-05-11

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Title notes ( 7 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	35321859	Available		35321859

AIMS: We sought to predict how many TAVIs patients could undergo in their lifetime using computed tomography (CT) simulation.

BACKGROUND: Given enough time, transcatheter heart valves (THVs) will degenerate and may require reintervention. Redo transcatheter aortic valve implantation (TAVI) is an attractive strategy but carries a risk of coronary obstruction.

CLINICALTRIAL: gov: NCT02628899; ClinicalTrial.gov: NCT03557242; ClinicalTrial.gov: NCT03423459.

CONCLUSIONS: Using cardiac CT simulation, it is possible to predict whether a patient can undergo multiple TAVI procedures in their lifetime. Those who cannot may prefer to undergo surgery first. CT simulation could provide a personalised lifetime management strategy for younger patients with symptomatic severe aortic stenosis and inform decision-making.

METHODS: We analysed paired CT scans (baseline and 30 days post-TAVI) from patients in the LRT trials and EPROMPT registry. We implanted virtual THVs on baseline CTs, comparing predicted valve-to-coronary (VTC) distances to 30-day CT VTC distances to evaluate the accuracy of CT simulation. We then simulated implantation of a second virtual THV within the first to estimate the risk of coronary obstruction due to sinus sequestration and the need for leaflet modification.

RESULTS: We included 213 patients with evaluable paired CTs. There was good agreement between virtual (baseline) and actual (30 days) CT measurements. CT simulation of TAVI followed by redo TAVI predicted low coronary obstruction risk in 25.4% of patients and high risk, likely necessitating leaflet modification, in 27.7%, regardless of THV type. The remaining 46.9% could undergo redo TAVI so long as the first THV was balloon-expandable but would likely require leaflet modification if the first THV was self-expanding.

English