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经导管主动脉瓣置换

Abstract

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Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients Comparison of 1-Year Pre- And Post-Transcatheter Aortic Valve Replacement Hospitalization Rates: A Population-Based Cohort Study Relationship Between Hospital Surgical Aortic Valve Replacement Volume and Transcatheter Aortic Valve Replacement Outcomes Transcatheter Aortic Valve Replacement in Patients With Multivalvular Heart Disease Impact of myocardial fibrosis on left ventricular remodelling, recovery, and outcome after transcatheter aortic valve implantation in different haemodynamic subtypes of severe aortic stenosis Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study Leaflet immobility and thrombosis in transcatheter aortic valve replacement Management of Asymptomatic Severe Aortic Stenosis: Evolving Concepts in Timing of Valve Replacement
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Original Research2020 Dec 4;CIRCINTERVENTIONS120009496.

JOURNAL：Circ Cardiovasc Interv. Article Link

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

BJ Forrestal, BC Case, C Yerasi et al. Keywords: coronary obstruction; heart valves; TAVR; valve-in-valve

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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.


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.


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.

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