Valvular & structural heart disease
Feasibility of redo-TAVI in self-expanding Evolut valves: a computed tomography (CT) analysis from the Evolut Low Risk Trial substudy
Authors' conclusion
The feasibility of redo-TAVI after Evolut failure is multifactorial and relates to the native annular anatomy, as well as the implantation depth of the index and second bioprostheses. Placement of an S3 at a lower Evolut position may reduce the risk of coronary flow compromise while preserving coronary access.
Study context
- Population
- Patients with self-expanding Evolut TAVI (post-TAVI CT scans, Evolut Low Risk CT substudy)
- Participants
- 204 post-TAVI CT scans
- Comparison
- Simulated redo-TAVI positions
- Primary endpoint
- Risk of coronary flow compromise after simulated redo-TAVI (neoskirt height and post-TAVI aortic root dimensions)
Methodological detailssimulation of redo-TAVI positions
- Simulation of redo-TAVI positions
Primary result
As reported in the abstract
Risk of coronary flow compromise
Further findings
Coronary accessibility
- Highest likelihood of preserving coronary accessibility with S3 outflow at Evolut node 4
Factors associated with coronary flow compromise (univariable)
- Higher risk with female sex, higher BMI, smaller annulus diameter, lower sinus of Valsalva height and width, shorter coronary height, smaller sinotubular junction diameter, shallower Evolut implant depth
Original publication
Feasibility of redo-TAVI in self-expanding Evolut valves: a CT analysis from the Evolut Low Risk Trial substudy. EuroIntervention. Published 17 July 2023. doi:10.
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