Valvular & structural heart disease
Impact of High Implantation of Transcatheter Aortic Valve on Subsequent Conduction Disturbances and Coronary Access
Authors' conclusion
High THV implantation substantially reduced conduction disturbances after TAVR. However, post-TAVR CT revealed that there is a risk for unfavorable future coronary access after TAVR and sinus sequestration in TAVR-in-TAVR.
Study context
- Population
- Patients undergoing transcatheter aortic valve replacement (TAVR) with Evolut R/PRO/PRO+ or SAPIEN 3 transcatheter heart valve (THVs), assessed by post-TAVR computed tomography (CT)Evolut R/PRO/PRO+ and SAPIEN 3 cohorts
- Exposure
- High implantation technique vs conventional implantation technique in TAVR
- Outcome
- Coronary access after TAVR on post-TAVR CT
Main finding
As reported in the abstract
Interference with access to 1 or both coronary ostia (post-TAVR CT)
Evolut: THV skirt interference
P = 0.03
Evolut: commissural post interference
SAPIEN 3: THV skirt interference
P = 1.00
SAPIEN 3: commissural tab interference
- High implantation technique (HIT) vs conventional implantation technique (CIT): P = 0.04 — Evolut: commissural posts
- HIT vs CIT: P = 0.93 — SAPIEN 3: commissural tabs
Observational data: associations, not effects.
Further findings
CT-identified risk of sinus sequestration in TAVR-in-TAVR
Evolut
P = 0.009
SAPIEN 3
P = 0.002
New conduction disturbances after TAVR
- HIT reduced the incidence of new conduction disturbances for both THVs
Original publication
Impact of High Implantation of Transcatheter Aortic Valve on Subsequent Conduction Disturbances and Coronary Access. JACC Cardiovasc Interv. Published 22 May 2023. doi:10.
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