TY  - BOOK
AU  - Ali, Syed
AU  - Ben-Dor, Itsik
AU  - Case, Brian C
AU  - Deksissa, Teshome
AU  - Forrestal, Brian J
AU  - Rogers, Toby
AU  - Satler, Lowell F
AU  - Shea, Corey
AU  - Shults, Christian
AU  - Waksman, Ron
AU  - Wang, John C
AU  - Weissman, Gaby
AU  - Yerasi, Charan
AU  - Zhang, Cheng
TI  - 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
SN  - 1941-7640
PY  - 2020///
KW  - *Aortic Valve Stenosis
KW  - *Coronary Occlusion
KW  - *Heart Valve Prosthesis
KW  - *Transcatheter Aortic Valve Replacement
KW  - Aortic Valve Stenosis/su [Surgery]
KW  - Aortic Valve/su [Surgery]
KW  - Feasibility Studies
KW  - Humans
KW  - Prosthesis Design
KW  - Risk Factors
KW  - Tomography
KW  - Treatment Outcome
KW  - United States
KW  - MedStar Heart & Vascular Institute
KW  - MedStar Union Memorial Hospital
KW  - Journal Article
N1  - Available online from MWHC library: 2008 - present
N2  - 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; 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; 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; 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
UR  - https://dx.doi.org/10.1161/CIRCINTERVENTIONS.120.009496
ER  -