Feasibility of Coronary Access and Aortic Valve Reintervention in Low-Risk TAVR Patients.
Document Type
Article
Publication Date
3-23-2020
Institution/Department
coronary access; coronary artery obstruction; percutaneous coronary intervention; transcatheter aortic valve replacement; valve-in-valve
Journal Title
JACC Cardiovasc Interv
MeSH Headings
Aged, Aortic Valve, Aortic Valve Stenosis, Bioprosthesis, Cardiac Catheterization, Computed Tomography Angiography, Coronary Angiography, Coronary Stenosis, Coronary Vessels, Feasibility Studies, Female, Heart Valve Prosthesis, Humans, Male, Multidetector Computed Tomography, Predictive Value of Tests, Prospective Studies, Prosthesis Design, Retreatment, Risk Factors, Severity of Illness Index, Time Factors, Transcatheter Aortic Valve Replacement, Treatment Outcome, United States
Abstract
OBJECTIVES: The aim of this study was to evaluate the feasibility of coronary access and aortic valve reintervention in low-risk patients undergoing transcatheter aortic valve replacement (TAVR) with a balloon-expandable transcatheter heart valve (THV).
BACKGROUND: Younger, low-risk TAVR patients are more likely than older, higher risk patients to require coronary angiography, percutaneous coronary intervention, or aortic valve reintervention, but their THVs may impede coronary access and cause coronary obstruction during TAVR-in-TAVR.
METHODS: The LRT (Low Risk TAVR) trial (NCT02628899) enrolled 200 subjects with symptomatic severe aortic stenosis to undergo TAVR using commercially available THVs. Subjects who received balloon-expandable THVs and who had 30-day cardiac computed tomographic scans were included in this study. In a subgroup, the feasibility of intentional THV crimping on the delivery catheter to pre-determine commissural alignment was tested.
RESULTS: In the LRT trial, 168 subjects received balloon-expandable THVs and had 30-day cardiac computed tomographic scans, of which 137 were of adequate image quality for analysis. The most challenging anatomy for coronary access (THV frame above and commissural suture post in front of a coronary ostium) was observed in 9% to 13% of subjects. Intentional THV crimping did not appear to meaningfully affect commissural alignment. The THV frame extended above the sinotubular junction in 21% of subjects, and in 13%, the distance between the THV and the sinotubular junction was <2 >mm, signifying that TAVR-in-TAVR may not be feasible without causing coronary obstruction.
CONCLUSIONS: TAVR may present challenges to future coronary access and aortic valve reintervention in a substantial number of low-risk patients.
ISSN
1876-7605
First Page
726
Last Page
735
Recommended Citation
Rogers, Toby; Greenspun, Benjamin C; Weissman, Gaby; Torguson, Rebecca; Craig, Paige; Shults, Christian; Gordon, Paul; Ehsan, Afshin; Wilson, Sean R; Goncalves, John; Levitt, Robert; Hahn, Chiwon; Parikh, Puja; Bilfinger, Thomas; Butzel, David; Buchanan, Scott; Hanna, Nicholas; Garrett, Robert; Buchbinder, Maurice; Asch, Federico; Garcia-Garcia, Hector M; Okubagzi, Petros; Ben-Dor, Itsik; Satler, Lowell F; and Waksman, Ron, "Feasibility of Coronary Access and Aortic Valve Reintervention in Low-Risk TAVR Patients." (2020). MaineHealth Maine Medical Center. 1949.
https://knowledgeconnection.mainehealth.org/mmc/1949