THV design must be improved to reduce coronary obstruction risk during TAVR-in-TAVR: Study

Washington, DC: Design improvements are needed for transcatheter heart valve (THV) as the current TAHV designs for 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. 

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