TY - JOUR
T1 - Balloon-Expandable Valve for Treatment of Evolut Valve Failure
T2 - Implications on Neoskirt Height and Leaflet Overhang
AU - Akodad, Mariama
AU - Sellers, Stephanie
AU - Landes, Uri
AU - Meier, David
AU - Tang, Gilbert H L
AU - Gada, Hemal
AU - Rogers, Toby
AU - Caskey, Michael
AU - Rutkin, Bruce
AU - Puri, Rishi
AU - Rovin, Joshua
AU - Leipsic, Jonathon
AU - Sondergaard, Lars
AU - Grubb, Kendra J
AU - Gleason, Patrick
AU - Garde, Kshitija
AU - Tadros, Hatem
AU - Teodoru, Sebastian
AU - Wood, David A
AU - Webb, John G
AU - Sathananthan, Janarthanan
N1 - Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2022/2/28
Y1 - 2022/2/28
N2 - OBJECTIVES: This study sought to determine the degree of Evolut (Medtronic) leaflet pinning, diameter expansion, leaflet overhang, and performance at different implant depths of the balloon-expandable Sapien 3 (S3, Edwards Lifesciences LLC) transcatheter heart valve (THV) within the Evolut THV.BACKGROUND: Preservation of coronary access and flow is a major factor when considering the treatment of failed Evolut THVs.METHODS: An in vitro study was performed with 20-, 23-, 26-, and 29-mm S3 THVs deployed within 23-, 26-, 29-, and 34-mm Evolut R THVs, respectively. The S3 outflow was positioned at various depths at node 4, 5, and 6 of the Evolut R. Neoskirt height, leaflet overhang, performance, and Evolut R valve housing diameter expansion were assessed under physiological conditions as per ISO 5840-3 standard.RESULTS: The neoskirt height for the Evolut R was shorter when the S3 outflow was positioned at node 4 compared with node 6 (node 4 height for 23 mm = 16.3 mm, 26 mm = 17.1 mm, 29 mm = 18.3 mm, and 34 mm = 19.9 mm vs node 6 height for 23 mm = 23.9 mm, 26 mm = 23.4 mm, 29 mm = 24.7 mm, and 34 mm = 27 mm Evolut R). All configurations exhibited acceptable hydrodynamic performance irrespective of the degree of leaflet overhang, except the 29-mm S3 implanted in 34-mm Evolut R at node 4 (regurgitant fraction >20%). The valve housing radius of the index Evolut R increased when the S3 was implanted, with the increase ranging from 0 to 2.5 mm.CONCLUSIONS: Placement of the S3 at a lower implant position within an index Evolut R reduces the neoskirt height with no significant compromise to S3 valve function despite a higher degree of leaflet overhang. Low S3 implantation may facilitate future coronary access after redo transcatheter aortic valve replacement.
AB - OBJECTIVES: This study sought to determine the degree of Evolut (Medtronic) leaflet pinning, diameter expansion, leaflet overhang, and performance at different implant depths of the balloon-expandable Sapien 3 (S3, Edwards Lifesciences LLC) transcatheter heart valve (THV) within the Evolut THV.BACKGROUND: Preservation of coronary access and flow is a major factor when considering the treatment of failed Evolut THVs.METHODS: An in vitro study was performed with 20-, 23-, 26-, and 29-mm S3 THVs deployed within 23-, 26-, 29-, and 34-mm Evolut R THVs, respectively. The S3 outflow was positioned at various depths at node 4, 5, and 6 of the Evolut R. Neoskirt height, leaflet overhang, performance, and Evolut R valve housing diameter expansion were assessed under physiological conditions as per ISO 5840-3 standard.RESULTS: The neoskirt height for the Evolut R was shorter when the S3 outflow was positioned at node 4 compared with node 6 (node 4 height for 23 mm = 16.3 mm, 26 mm = 17.1 mm, 29 mm = 18.3 mm, and 34 mm = 19.9 mm vs node 6 height for 23 mm = 23.9 mm, 26 mm = 23.4 mm, 29 mm = 24.7 mm, and 34 mm = 27 mm Evolut R). All configurations exhibited acceptable hydrodynamic performance irrespective of the degree of leaflet overhang, except the 29-mm S3 implanted in 34-mm Evolut R at node 4 (regurgitant fraction >20%). The valve housing radius of the index Evolut R increased when the S3 was implanted, with the increase ranging from 0 to 2.5 mm.CONCLUSIONS: Placement of the S3 at a lower implant position within an index Evolut R reduces the neoskirt height with no significant compromise to S3 valve function despite a higher degree of leaflet overhang. Low S3 implantation may facilitate future coronary access after redo transcatheter aortic valve replacement.
KW - Aortic Valve/diagnostic imaging
KW - Aortic Valve Stenosis/surgery
KW - Heart Valve Prosthesis
KW - Humans
KW - Prosthesis Design
KW - Transcatheter Aortic Valve Replacement/adverse effects
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85124315142&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2021.12.021
DO - 10.1016/j.jcin.2021.12.021
M3 - Journal article
C2 - 35210043
SN - 1936-8798
VL - 15
SP - 368
EP - 377
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 4
ER -