Washington, DC: Design Improvements Needed for Transcatheter Heart Valve

Design improvements are needed for transcatheter heart valve (THV) as the current TAHV designs may lead to coronary obstruction during TAVR-in-TAVR and cause problems with future coronary access, reveals a recent study. The study is published in the journal Circulation: Cardiovascular Interventions.

The tall stent frame and supra-annular leaflet position of the self-expanding Evolut PRO or Evolut PRO+ THVs may cause coronary occlusion during transcatheter aortic valve replacement (TAVR)-in-TAVR and present challenges for future coronary access. Ron Waksman, MedStar Washington Hospital Center, Washington, DC, and colleagues therefore sought to evaluate the risk of TAVR-in-TAVR with Evolut PRO or Evolut PRO+ THVs and the feasibility of future coronary access.

The CoreValve Evolut PRO Prospective Registry prospectively enrolled eighty-one patients with symptomatic severe aortic stenosis to undergo TAVR using a commercially available latest generation self-expanding THV at 2 centers in the United States. Computed tomography was performed 30 days after TAVR, which the researchers used to simulate TAVR-in-TAVR with a second Evolut PRO or Evolut PRO+ THV and evaluate for risk of coronary obstruction and feasibility of future coronary access.

Key Findings of the Study Include:

• Computed tomography simulation predicted sinus of Valsalva sequestration and resultant coronary obstruction during future TAVR-in-TAVR in up to 23% of patients.
• Computed tomography simulation predicted that the position of the pinned THV leaflets would hinder future coronary access in up to 78% of patients after TAVR-in-TAVR.

Based on the above findings, the researchers concluded that further THV design improvements and leaflet modification strategies are needed to lessen the risk of coronary obstruction during TAVR-in-TAVR with self-expanding THVs and to facilitate future coronary access.

"Risk of Coronary Obstruction and Feasibility of Coronary Access After Repeat Transcatheter Aortic Valve Replacement With the Self-Expanding Evolut Valve: A Computed Tomography Simulation Study," is published in the journal Circulation: Cardiovascular Interventions.

DOI: https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.120.009496