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

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) and Evolut PRO+ (Medtronic, Minneapolis, Minnesota).

METHODS

Fifteen computed tomography (CT)-based patient-specific aortic models were 3D-printed and implanted with specific SAVs and with the two 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 utilized to assess procedures. CT of the models was obtained.

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 as compared to 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 (11.3vs.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).

CONCLUSIONS

The rate of successful CA and PCI following ViV-TAVR was higher with ACURATE neo2 as compared to Evolut PRO+. The differences in SS-TAVs design impacted the cannulation approach and subsequent procedural outcomes.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.