Author + information
- Received December 3, 2019
- Revision received January 7, 2020
- Accepted January 28, 2020
- Published online March 16, 2020.
- Mohammad Abdelghani, MD, PhDa,b,c,∗ (, )
- Martin Landt, MDa,
- Hussein Traboulsi, MDa,
- Björn Becker, MDa and
- Gert Richardt, MDa
- aHeart Center, Segeberger Kliniken, Bad Segeberg, Germany
- bDepartment of Cardiology, Al-Azhar University, Cairo, Egypt
- cCardiology Department, the Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- ↵∗Address for correspondence:
Dr. Mohammad Abdelghani, Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795 Bad Segeberg, Germany.
Objectives The authors sought to estimate possible interference of the Medtronic Evolut R/Pro transcatheter heart valve (THV) frame with coronary access using multislice computed tomography (MSCT) data.
Background Lower-risk patients undergoing transcatheter aortic valve replacement (TAVR) endure a high cumulative risk of coronary events, but coronary access can be challenging.
Methods In 101 patients who received an Evolut R/Pro THV, post-TAVR MSCT (performed at a median of 30 days after TAVR) was used to assess possible interference of the elements of the THV frame with coronary access.
Results The closest cell of the THV frame vertically aligned with the coronary ostium was located opposite the ostium in 58% and 63%, below the ostium in 22% and 30%, or above the ostium in 20% and 7% of left and right coronary arteries, respectively. The free sinus of Valsalva space between the THV frame and the coronary ostium was 0.45 ± 0.17 cm and 0.44 ± 0.17 cm for the left and right coronary arteries, respectively, and showed a stepwise decrease with decreasing THV size (p < 0.001). Bioprosthetic valve commissures were antianatomic (i.e., not aligned with native commissures) in 45 patients (47%), and the commissural post was overlapping a coronary ostium in 15 patients (16%). Two patients (2.0%) had a possible interference of the paravalvular sealing skirt with coronary access.
Conclusions Using post-TAVR MSCT data, the main mechanism of potential interference of Evolut R/Pro frame with coronary access was an antianatomic commissural post overlapping the coronary ostium.
Dr. Richardt has received institutional research grants from St. Jude Medical, Biotronik, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 3, 2019.
- Revision received January 7, 2020.
- Accepted January 28, 2020.
- 2020 American College of Cardiology Foundation
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