Coronary Access After TAVR-in-TAVR as Evaluated by Multidetector Computed Tomography

Ole De Backer; Uri Landes; Andreas Fuchs; Sung-Han Yoon; Ole Norling Mathiassen; Alexander Sedaghat; Won-Keun Kim; Thomas Pilgrim; Nicola Buzzatti; Philipp Ruile; Abdallah El Sabbagh; Marco Barbanti; Claudia Fiorina; Luis Nombela-Franco; Arie Steinvil; Ariel Finkelstein; Matteo Montorfano; Pal Maurovich-Horvat; Klaus Fuglsang Kofoed; Philipp Blanke; Matjaz Bunc; Franz-Josef Neumann; Azeem Latib; Stephan Windecker; Jan-Malte Sinning; Bjarne Linde Norgaard; Raj Makkar; John G Webb; Lars Søndergaard

doi:10.1016/j.jcin.2020.06.016

Coronary Access After TAVR-in-TAVR as Evaluated by Multidetector Computed Tomography

Ole De Backer, Uri Landes, Andreas Fuchs, Sung-Han Yoon, Ole Norling Mathiassen, Alexander Sedaghat, Won-Keun Kim, Thomas Pilgrim, Nicola Buzzatti, Philipp Ruile, Abdallah El Sabbagh, Marco Barbanti, Claudia Fiorina, Luis Nombela-Franco, Arie Steinvil, Ariel Finkelstein, Matteo Montorfano, Pal Maurovich-Horvat, Klaus Fuglsang Kofoed, Philipp BlankeMatjaz Bunc, Franz-Josef Neumann, Azeem Latib, Stephan Windecker, Jan-Malte Sinning, Bjarne Linde Norgaard, Raj Makkar, John G Webb, Lars Søndergaard

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Abstract

OBJECTIVES: The aim of this study was to assess coronary accessibility after transcatheter aortic valve replacement (TAVR)-in-TAVR using multidetector computed tomography.

BACKGROUND: Expanding TAVR to patients with longer life expectancy may involve more frequent bioprosthetic valve failure and need for redo TAVR. Coronary access after TAVR-in-TAVR may be challenging, particularly as the leaflets from the initial transcatheter heart valve (THV) will form a neo-skirt following TAVR-in-TAVR.

METHODS: In 45 patients treated with different combinations of CoreValve and Evolut (CV/EV) THVs with supra-annular leaflet position and SAPIEN THVs with intra-annular leaflet position, post-TAVR-in-TAVR multidetector computed tomographic scans were analyzed to examine coronary accessibility.

RESULTS: After TAVR-in-TAVR, the coronary arteries originated below the top of the neo-skirt in 90% of CV/EV-first cases compared with 67% of SAPIEN-first cases (p = 0.009). For these coronary arteries originating below the top of the neo-skirt, the distance between the THV and the aortic wall was <3 mm in 56% and 25% of CV/EV-first and SAPIEN-first cases, respectively (p = 0.035). Coronary access may be further complicated by THV-THV stent frame strut misalignment in 53% of CV/EV-in-CV/EV cases. The risk for technically impossible coronary access was 27% and 10% in CV/EV-first and SAPIEN-first cases, respectively (p = 0.121). Absence of THV interference with coronary accessibility can be expected in 8% and 33% of CV/EV-first and SAPIEN-first cases, respectively (p = 0.005).

CONCLUSIONS: Coronary access after TAVR-in-TAVR may be challenging in a significant proportion of patients. THVs with intra-annular leaflet position or low commissural height and large open cells may be preferable in terms of coronary access after TAVR-in-TAVR.

Originalsprog	Engelsk
Tidsskrift	JACC: Cardiovascular Interventions
Vol/bind	13
Udgave nummer	21
Sider (fra-til)	2528-2538
Antal sider	11
ISSN	1936-8798
DOI	https://doi.org/10.1016/j.jcin.2020.06.016
Status	Udgivet - 9 nov. 2020

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10.1016/j.jcin.2020.06.016

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De Backer, O., Landes, U., Fuchs, A., Yoon, S.-H., Mathiassen, O. N., Sedaghat, A., Kim, W.-K., Pilgrim, T., Buzzatti, N., Ruile, P., El Sabbagh, A., Barbanti, M., Fiorina, C., Nombela-Franco, L., Steinvil, A., Finkelstein, A., Montorfano, M., Maurovich-Horvat, P., Kofoed, K. F., ... Søndergaard, L. (2020). Coronary Access After TAVR-in-TAVR as Evaluated by Multidetector Computed Tomography. JACC: Cardiovascular Interventions, 13(21), 2528-2538. https://doi.org/10.1016/j.jcin.2020.06.016

De Backer, O, Landes, U, Fuchs, A, Yoon, S-H, Mathiassen, ON, Sedaghat, A, Kim, W-K, Pilgrim, T, Buzzatti, N, Ruile, P, El Sabbagh, A, Barbanti, M, Fiorina, C, Nombela-Franco, L, Steinvil, A, Finkelstein, A, Montorfano, M, Maurovich-Horvat, P, Kofoed, KF, Blanke, P, Bunc, M, Neumann, F-J, Latib, A, Windecker, S, Sinning, J-M, Norgaard, BL, Makkar, R, Webb, JG & Søndergaard, L 2020, 'Coronary Access After TAVR-in-TAVR as Evaluated by Multidetector Computed Tomography', JACC: Cardiovascular Interventions, bind 13, nr. 21, s. 2528-2538. https://doi.org/10.1016/j.jcin.2020.06.016

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title = "Coronary Access After TAVR-in-TAVR as Evaluated by Multidetector Computed Tomography",

abstract = "OBJECTIVES: The aim of this study was to assess coronary accessibility after transcatheter aortic valve replacement (TAVR)-in-TAVR using multidetector computed tomography.BACKGROUND: Expanding TAVR to patients with longer life expectancy may involve more frequent bioprosthetic valve failure and need for redo TAVR. Coronary access after TAVR-in-TAVR may be challenging, particularly as the leaflets from the initial transcatheter heart valve (THV) will form a neo-skirt following TAVR-in-TAVR.METHODS: In 45 patients treated with different combinations of CoreValve and Evolut (CV/EV) THVs with supra-annular leaflet position and SAPIEN THVs with intra-annular leaflet position, post-TAVR-in-TAVR multidetector computed tomographic scans were analyzed to examine coronary accessibility.RESULTS: After TAVR-in-TAVR, the coronary arteries originated below the top of the neo-skirt in 90% of CV/EV-first cases compared with 67% of SAPIEN-first cases (p = 0.009). For these coronary arteries originating below the top of the neo-skirt, the distance between the THV and the aortic wall was <3 mm in 56% and 25% of CV/EV-first and SAPIEN-first cases, respectively (p = 0.035). Coronary access may be further complicated by THV-THV stent frame strut misalignment in 53% of CV/EV-in-CV/EV cases. The risk for technically impossible coronary access was 27% and 10% in CV/EV-first and SAPIEN-first cases, respectively (p = 0.121). Absence of THV interference with coronary accessibility can be expected in 8% and 33% of CV/EV-first and SAPIEN-first cases, respectively (p = 0.005).CONCLUSIONS: Coronary access after TAVR-in-TAVR may be challenging in a significant proportion of patients. THVs with intra-annular leaflet position or low commissural height and large open cells may be preferable in terms of coronary access after TAVR-in-TAVR.",

keywords = "computed tomography, coronary access, transcatheter aortic valve",

author = "{De Backer}, Ole and Uri Landes and Andreas Fuchs and Sung-Han Yoon and Mathiassen, {Ole Norling} and Alexander Sedaghat and Won-Keun Kim and Thomas Pilgrim and Nicola Buzzatti and Philipp Ruile and {El Sabbagh}, Abdallah and Marco Barbanti and Claudia Fiorina and Luis Nombela-Franco and Arie Steinvil and Ariel Finkelstein and Matteo Montorfano and Pal Maurovich-Horvat and Kofoed, {Klaus Fuglsang} and Philipp Blanke and Matjaz Bunc and Franz-Josef Neumann and Azeem Latib and Stephan Windecker and Jan-Malte Sinning and Norgaard, {Bjarne Linde} and Raj Makkar and Webb, {John G} and Lars S{\o}ndergaard",

year = "2020",

month = nov,

day = "9",

doi = "10.1016/j.jcin.2020.06.016",

language = "English",

volume = "13",

pages = "2528--2538",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "21",

}

TY - JOUR

T1 - Coronary Access After TAVR-in-TAVR as Evaluated by Multidetector Computed Tomography

AU - De Backer, Ole

AU - Landes, Uri

AU - Fuchs, Andreas

AU - Yoon, Sung-Han

AU - Mathiassen, Ole Norling

AU - Sedaghat, Alexander

AU - Kim, Won-Keun

AU - Pilgrim, Thomas

AU - Buzzatti, Nicola

AU - Ruile, Philipp

AU - El Sabbagh, Abdallah

AU - Barbanti, Marco

AU - Fiorina, Claudia

AU - Nombela-Franco, Luis

AU - Steinvil, Arie

AU - Finkelstein, Ariel

AU - Montorfano, Matteo

AU - Maurovich-Horvat, Pal

AU - Kofoed, Klaus Fuglsang

AU - Blanke, Philipp

AU - Bunc, Matjaz

AU - Neumann, Franz-Josef

AU - Latib, Azeem

AU - Windecker, Stephan

AU - Sinning, Jan-Malte

AU - Norgaard, Bjarne Linde

AU - Makkar, Raj

AU - Webb, John G

AU - Søndergaard, Lars

PY - 2020/11/9

Y1 - 2020/11/9

N2 - OBJECTIVES: The aim of this study was to assess coronary accessibility after transcatheter aortic valve replacement (TAVR)-in-TAVR using multidetector computed tomography.BACKGROUND: Expanding TAVR to patients with longer life expectancy may involve more frequent bioprosthetic valve failure and need for redo TAVR. Coronary access after TAVR-in-TAVR may be challenging, particularly as the leaflets from the initial transcatheter heart valve (THV) will form a neo-skirt following TAVR-in-TAVR.METHODS: In 45 patients treated with different combinations of CoreValve and Evolut (CV/EV) THVs with supra-annular leaflet position and SAPIEN THVs with intra-annular leaflet position, post-TAVR-in-TAVR multidetector computed tomographic scans were analyzed to examine coronary accessibility.RESULTS: After TAVR-in-TAVR, the coronary arteries originated below the top of the neo-skirt in 90% of CV/EV-first cases compared with 67% of SAPIEN-first cases (p = 0.009). For these coronary arteries originating below the top of the neo-skirt, the distance between the THV and the aortic wall was <3 mm in 56% and 25% of CV/EV-first and SAPIEN-first cases, respectively (p = 0.035). Coronary access may be further complicated by THV-THV stent frame strut misalignment in 53% of CV/EV-in-CV/EV cases. The risk for technically impossible coronary access was 27% and 10% in CV/EV-first and SAPIEN-first cases, respectively (p = 0.121). Absence of THV interference with coronary accessibility can be expected in 8% and 33% of CV/EV-first and SAPIEN-first cases, respectively (p = 0.005).CONCLUSIONS: Coronary access after TAVR-in-TAVR may be challenging in a significant proportion of patients. THVs with intra-annular leaflet position or low commissural height and large open cells may be preferable in terms of coronary access after TAVR-in-TAVR.

AB - OBJECTIVES: The aim of this study was to assess coronary accessibility after transcatheter aortic valve replacement (TAVR)-in-TAVR using multidetector computed tomography.BACKGROUND: Expanding TAVR to patients with longer life expectancy may involve more frequent bioprosthetic valve failure and need for redo TAVR. Coronary access after TAVR-in-TAVR may be challenging, particularly as the leaflets from the initial transcatheter heart valve (THV) will form a neo-skirt following TAVR-in-TAVR.METHODS: In 45 patients treated with different combinations of CoreValve and Evolut (CV/EV) THVs with supra-annular leaflet position and SAPIEN THVs with intra-annular leaflet position, post-TAVR-in-TAVR multidetector computed tomographic scans were analyzed to examine coronary accessibility.RESULTS: After TAVR-in-TAVR, the coronary arteries originated below the top of the neo-skirt in 90% of CV/EV-first cases compared with 67% of SAPIEN-first cases (p = 0.009). For these coronary arteries originating below the top of the neo-skirt, the distance between the THV and the aortic wall was <3 mm in 56% and 25% of CV/EV-first and SAPIEN-first cases, respectively (p = 0.035). Coronary access may be further complicated by THV-THV stent frame strut misalignment in 53% of CV/EV-in-CV/EV cases. The risk for technically impossible coronary access was 27% and 10% in CV/EV-first and SAPIEN-first cases, respectively (p = 0.121). Absence of THV interference with coronary accessibility can be expected in 8% and 33% of CV/EV-first and SAPIEN-first cases, respectively (p = 0.005).CONCLUSIONS: Coronary access after TAVR-in-TAVR may be challenging in a significant proportion of patients. THVs with intra-annular leaflet position or low commissural height and large open cells may be preferable in terms of coronary access after TAVR-in-TAVR.

KW - computed tomography

KW - coronary access

KW - transcatheter aortic valve

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U2 - 10.1016/j.jcin.2020.06.016

DO - 10.1016/j.jcin.2020.06.016

M3 - Journal article

C2 - 33153567

SN - 1936-8798

VL - 13

SP - 2528

EP - 2538

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 21

ER -

Coronary Access After TAVR-in-TAVR as Evaluated by Multidetector Computed Tomography

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