Impact of Initial Evolut Transcatheter Aortic Valve Replacement Deployment Orientation on Final Valve Orientation and Coronary Reaccess
Key result
Outer curve or center front EvolutR/Pro Hat deployment linked to ~69% less severe neo-commissural overlap.
- P<0.001
- n=118
Why the study?
Transcatheter heart valve neo-commissures cannot be predictably aligned with native commissures during TAVR, which may interfere with coronary orifices and affect reaccess.
Does initial deployment orientation of the EvolutR/Pro transcatheter valve affect final neo-commissural orientation and severity of overlap with the coronaries in patients undergoing TAVR?
Population
118 transfemoral EvolutR/Pro TAVR patients at 2 centers
Comparison
Capsule Hat orientation at outer curve/center front vs inner curve/center back during deployment
Design
Two-center retrospective study
Authors
Discussion
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Member takes
Implication
Initial Evolut “hat” orientation at outer curve/center front reduces severe coronary overlap; leaves open whether technique improves reaccess or long-term outcomes.
Study Design
Type
Observational (n=118)
Multicenter
Yes
Structured PICO
Does initial deployment orientation of the EvolutR/Pro transcatheter valve affect final neo-commissural orientation and severity of overlap with the coronaries in patients undergoing TAVR?
P
Population
118 patients undergoing transfemoral EvolutR/Pro transcatheter aortic valve replacement at 2 centers.
E
Exposure
Initial deployment orientation of the EvolutR/Pro transcatheter valve with capsule Hat at outer curve (OC) or center front (CF).
C
Comparator
Initial deployment orientation with capsule Hat at inner curve or center back.
O
Outcome
Final neo-commissural orientation and severity of overlap with the coronary orifices (left main and right coronary artery).surrogate
Main Result
Absolute Event Rate: 23.2% vs 75%
p-value: p=<0.001
Initial deployment orientation of the EvolutR/Pro valve significantly impacts final neo-commissural overlap with coronary arteries, with outer curve/center front positioning reducing severe overlap.
Cite This Study
Tang et al. (2019) conducted an observational in Transcatheter aortic valve replacement (n=118). Capsule Hat orientation at outer curve/center front vs. Capsule Hat orientation at inner curve/center back was evaluated on Severe neo-commissural overlap with 1 or both coronary arteries (p=<0.001). Initial deployment of the EvolutR/Pro valve with the capsule Hat at the outer curve or center front resulted in significantly less severe neo-commissural overlap with one or both coronary arteries compared to inner curve or center back (23.2% vs 75.0%; P<0.001).