Computed Tomography-Based Evaluation of Redo-Transcatheter Aortic Valve Replacement Feasibility for Self-Expanding Valves

BACKGROUND: Redo-transcatheter aortic valve replacement (TAVR) may be unfeasible due to the risk of coronary flow compromise by the pinned-back leaflets of the index transcatheter aortic valve (TAV). This study aimed to evaluate the feasibility of redo-TAVR using a balloon-expandable SAPIEN 3 (S3, Edwards Lifesciences, USA) implanted within the intra-annular self-expanding Navitor TAV (Abbott, USA).

METHODS: A total of 106 post-TAVR computed tomography scans of patients who underwent Navitor implantation were analyzed. Redo-TAVR using an S3 was simulated in 2 positions: S3 outflow to node 2 of the Navitor (low implant) and S3 outflow to the base of the Navitor commissural posts (high implant). The overall coronary risk, determined by the risk of coronary flow compromise and coronary inaccessibility, was determined by the height of the neoskirt plane and the valve-to-aorta distances.

RESULTS: At a low S3 implant position, the overall coronary risk was high for only 1% of patients, but this increased to 39% with a high S3 implant position. If the high S3 implant was combined with a high index Navitor implant depth, 73% of patients were deemed high coronary risk, which could be reduced to 28% in case of an index Navitor implant depth >5 mm. At both S3 implant depths, redo-TAVR in Navitor was associated with a lower coronary risk compared to redo-TAVR in supra-annular self-expanding valves.

CONCLUSIONS: The feasibility of redo-TAVR following S3-in-self-expanding valve depends on the type and implant depth of the index TAV as well as the implant depth of the second TAV.