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Balloon-Expandable Valve for Treatment of Evolut Valve Failure: Implications on Neoskirt Height and Leaflet Overhang

Research output: Contribution to journalJournal articlepeer-review

  1. Coronary Access Following Redo TAVR: Impact of THV Design, Implant Technique, and Cell Misalignment

    Research output: Contribution to journalJournal articlepeer-review

  2. Neo-Commissural Alignment During Transcatheter Aortic Valve Replacement: The LACRCO Algorithm

    Research output: Contribution to journalJournal articlepeer-review

  3. Outcomes of Redo Transcatheter Aortic Valve Replacement According to the Initial and Subsequent Valve Type

    Research output: Contribution to journalJournal articlepeer-review

  1. Transcatheter aortic valve-in-valve implantation to treat aortic Para-valvular regurgitation after TAVI

    Research output: Contribution to journalJournal articlepeer-review

  2. Coronary Access Following Redo TAVR: Impact of THV Design, Implant Technique, and Cell Misalignment

    Research output: Contribution to journalJournal articlepeer-review

  • Mariama Akodad
  • Stephanie Sellers
  • Uri Landes
  • David Meier
  • Gilbert H L Tang
  • Hemal Gada
  • Toby Rogers
  • Michael Caskey
  • Bruce Rutkin
  • Rishi Puri
  • Joshua Rovin
  • Jonathon Leipsic
  • Lars Sondergaard
  • Kendra J Grubb
  • Patrick Gleason
  • Kshitija Garde
  • Hatem Tadros
  • Sebastian Teodoru
  • David A Wood
  • John G Webb
  • Janarthanan Sathananthan
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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.

Original languageEnglish
JournalJACC: Cardiovascular Interventions
Volume15
Issue number4
Pages (from-to)368-377
Number of pages10
ISSN1936-8798
DOIs
Publication statusPublished - 28 Feb 2022

Bibliographical note

Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

    Research areas

  • Aortic Valve/diagnostic imaging, Aortic Valve Stenosis/surgery, Heart Valve Prosthesis, Humans, Prosthesis Design, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome

ID: 79744765