Key result
Computed tomography simulation of TAVR-in-TAVR with self-expanding Evolut valves predicted coronary obstruction in up to 23% of patients and hindered future coronary access in up to 78%.
Why the study?
The supra-annular leaflet position and tall stent frame of self-expanding Evolut PRO/PRO+ valves may cause coronary occlusion during TAVR-in-TAVR and hinder future coronary access.
What is the risk of coronary obstruction and feasibility of future coronary access during TAVR-in-TAVR with Evolut PRO or Evolut PRO+ THVs in patients with severe aortic stenosis?
Comparison
CT simulation of TAVR-in-TAVR with a second Evolut PRO or Evolut PRO+ THV
Design
Prospective registry-based CT simulation study at 2 centers
Follow-up
30 days
Authors
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May warrant caution selecting Evolut patients for TAVR-in-TAVR; hypothesis-generating for clinical outcomes and THV redesign.
Observational (n=81)
Yes
What is the risk of coronary obstruction and feasibility of future coronary access during TAVR-in-TAVR with Evolut PRO or Evolut PRO+ THVs in patients with severe aortic stenosis?
CT simulation indicates a significant risk of coronary obstruction and impaired coronary access during repeat TAVR with self-expanding Evolut valves, emphasizing the need for modified THV designs or leaflet modification strategies.
Forrestal et al. (2020) conducted an observational in Symptomatic severe aortic stenosis (n=81). Simulated TAVR-in-TAVR with Evolut PRO or Evolut PRO+ THVs was evaluated on Predicted sinus of Valsalva sequestration and resultant coronary obstruction. Computed tomography simulation of TAVR-in-TAVR with self-expanding Evolut valves predicted coronary obstruction in up to 23% of patients and hindered future coronary access in up to 78%.
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