Key result
In ex vivo 3D-printed models of patients who underwent ViV-TAVI with the ACURATE neo valve, diagnostic angiography and PCI were highly feasible, achieved in 97% and 95% of cases, respectively.
Why the study?
Coronary access after TAVI with supra-annular self-expandable valves can be challenging, and little data exist regarding coronary access after ViV-TAVI for degenerated surgical bioprostheses.
Is coronary access feasible in patient-specific 3D models following transcatheter aortic valve-in-valve implantation with the ACURATE neo valve?
Is coronary access feasible in patient-specific 3D models following transcatheter aortic valve-in-valve implantation with the ACURATE neo valve?
In patient-specific 3D models, diagnostic angiography and PCI were highly feasible following ViV-TAVI with the ACURATE neo valve, though prophylactic stenting and narrow aortic dimensions increased cannulation difficulty.
May inform valve selection for future coronary access; hypothesis-generating and requires in vivo confirmation before practice change.
Background Coronary access after transcatheter aortic valve implantation (TAVI) with supra-annular self-expandable valves may be challenging or un-feasible. There is little data concerning coronary access following transcatheter aortic valve-in-valve implantation (ViV-TAVI) for degenerated surgical bioprosthesis. Aims To evaluate the feasibility and challenge of coronary access after ViV-TAVI with the supra-annular self-expandable ACURATE neo valve. Materials and methods Sixteen patients underwent ViV-TAVI with the ACURATE neo valve. Post-procedural computed tomography (CT) was used to create 3D-printed life-sized patient-specific models for bench-testing of coronary cannulation. Primary endpoint was feasibility of diagnostic angiography and PCI. Secondary endpoints included incidence of challenging cannulation for both diagnostic catheters (DC) and guiding catheters (GC). The association between challenging cannulations with aortic and transcatheter/surgical valve geometry was evaluated using pre and post-procedural CT scans. Results Diagnostic angiography and PCI were feasible for 97 and 95% of models respectively. All non-feasible procedures occurred in ostia that underwent prophylactic “chimney” stenting. DC cannulation was challenging in 17% of models and was associated with a narrower SoV width (30 vs. 35 mm, p < 0.01), STJ width (28 vs. 32 mm, p < 0.05) and shorter STJ height (15 vs. 17 mm, p < 0.05). GC cannulation was challenging in 23% of models and was associated with narrower STJ width (28 vs. 32 mm, p < 0.05), smaller transcatheter-to-coronary distance (5 vs. 9.2 mm, p < 0.05) and a worse coronary-commissural overlap angle (14.3° vs. 25.6 o , p < 0.01). Advanced techniques to achieve GC cannulation were required in 22/64 (34%) of cases. Conclusion In this exploratory bench analysis, diagnostic angiography and PCI was feasible in almost all cases following ViV-TAVI with the ACURATE neo valve. Prophylactic coronary stenting, higher implantation, narrower aortic sinus dimensions and commissural misalignment were associated with an increased challenge of coronary cannulation.
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Khokhar et al. (2022) studied Degenerated surgical bioprosthetic valves treated with ViV-TAVI (n=16). ACURATE neo valve implantation (ex vivo simulation) was evaluated on Feasibility of diagnostic angiography. In ex vivo 3D-printed models of patients who underwent ViV-TAVI with the ACURATE neo valve, diagnostic angiography and PCI were highly feasible, achieved in 97% and 95% of cases, respectively.
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