MedStar Authors catalog › Details for: Risk of Coronary Obstruction and Feasibility of Coronary Access After Repeat Transcatheter Aortic Valve Replacement With the Self-Expanding Evolut Valve: A Computed Tomography Simulation Study.
Citation: Circulation: Cardiovascular Interventions. 13(12):e009496, 2020 Dec..Journal: Circulation. Cardiovascular interventions.Published: ; 2020ISSN: 1941-7640.Full author list: Forrestal BJ; Case BC; Yerasi C; Shea C; Torguson R; Zhang C; Ben-Dor I; Deksissa T; Ali S; Satler LF; Shults C; Weissman G; Wang JC; Khan JM; Waksman R; Rogers T.UI/PMID: 33272031.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Heart & Vascular Institute | MedStar Union Memorial HospitalActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1161/CIRCINTERVENTIONS.120.009496 (Click here)Abbreviated citation: Circ., Cardiovasc. interv.. 13(12):e009496, 2020 Dec.Local Holdings: Available online from MWHC library: 2008 - present.Abstract: BACKGROUND: The supra-annular leaflet position and tall stent frame of the self-expanding Evolut PRO or Evolut PRO+ transcatheter heart valves (THVs) may cause coronary occlusion during transcatheter aortic valve replacement (TAVR)-in-TAVR and present challenges for future coronary access. We sought to evaluate the risk of TAVR-in-TAVR with Evolut PRO or Evolut PRO+ THVs and the feasibility of future coronary access.Abstract: METHODS: The CoreValve Evolut PRO Prospective Registry (EPROMPT; NCT03423459) prospectively enrolled patients with symptomatic severe aortic stenosis to undergo TAVR using a commercially available latest generation self-expanding THV at 2 centers in the United States. Computed tomography was performed 30 days after TAVR, which we used to simulate TAVR-in-TAVR with a second Evolut PRO or Evolut PRO+ THV and evaluate for risk of coronary obstruction and feasibility of future coronary access.Abstract: RESULTS: Eighty-one patients enrolled with interpretable computed tomography are reported herein. Computed tomography simulation predicted sinus of Valsalva sequestration and resultant coronary obstruction during future TAVR-in-TAVR in up to 23% of patients. Computed tomography simulation predicted that the position of the pinned THV leaflets would hinder future coronary access in up to 78% of patients after TAVR-in-TAVR.Abstract: CONCLUSIONS: Further THV design improvements and leaflet modification strategies are needed to mitigate the risk of coronary obstruction during TAVR-in-TAVR with self-expanding THVs and to facilitate future coronary access. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03423459.