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Coronary Access and PCI after Transcatheter Aortic Valve Replacement With Different Self-Expanding Platforms in Failed Surgical Valves.

Authors :
Giannini F
Khokhar AA
Curio J
Beneduce A
Montonati C
Fabris E
Gallo F
Zlahoda-Huzior A
Gallone G
Kim WK
Ielasi A
Pellicano M
Spratt JC
Latib A
De Backer O
Dudek D
Source :
The Canadian journal of cardiology [Can J Cardiol] 2024 Nov; Vol. 40 (11), pp. 2010-2020. Date of Electronic Publication: 2024 Aug 22.
Publication Year :
2024

Abstract

Background: Coronary access (CA) and percutaneous coronary intervention (PCI) might be challenging after valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) with supra-annular self-expanding valves (SS-TAVs) in surgical aortic valves (SAVs). Our study aim was to compare feasibility, predictors, and techniques of CA and PCI following ViV-TAVR with ACURATE neo2 (Boston Scientific, Marlborough, MA) and Evolut PRO+ (Medtronic, Minneapolis, MN).<br />Methods: Fifteen computed tomography (CT)-based patient-specific aortic models were 3-dimensionally (3D) printed and implanted with specific SAVs and with the 2 SS-TAVs with commissural alignment. Two operators attempted CA (n = 120) and PCI (n = 120) of each coronary artery in a pulsatile-flow-simulator, under real catheterization laboratory conditions. The primary endpoints were the rate of successful CA and PCI. Outcomes with different SS-TAVs were directly compared. An internally mounted borescope camera was used to assess procedures. CT of the models was obtained.<br />Results: ACURATE neo2 showed significantly higher rates of successful CA (96.7% vs 75%, P = 0.001) and PCI (98.3% vs 85%, P = 0.008) and was associated with a shorter procedural time compared with Evolut PRO+. Independent predictors of unsuccessful CA and PCI were smaller SAV size and Evolut PRO+. The advantage of ACURATE neo2 was mediated by a larger valve-to-anatomy distance at the top of the leaflet plane (11.3 mm vs 4.8 mm), facilitating more often an external cannulation approach for both CA (36.7% vs 15%, P < 0.001) and PCI (36.7% vs 21.7%, P = 0.013).<br />Conclusions: The rate of successful CA and PCI following ViV-TAVR was higher with ACURATE neo2 compared with Evolut PRO+. The differences in SS-TAVs design affected the cannulation approach and subsequent procedural outcomes.<br /> (Copyright © 2024 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1916-7075
Volume :
40
Issue :
11
Database :
MEDLINE
Journal :
The Canadian journal of cardiology
Publication Type :
Academic Journal
Accession number :
39179204
Full Text :
https://doi.org/10.1016/j.cjca.2024.07.030