Assessing Potential Risks of Future Redo Transcatheter Aortic Valve Replacement in Asian Patients

Norihisa Miyawaki; Kenichi Ishizu; Shinichi Shirai; Kenji Nakano; Tadatomo Fukushima; Euihong Ko; Yasuo Tsuru; Hiroaki Tashiro; Miho Nakamura; Hiroyuki Tabata; Toru Morofuji; Takashi Morinaga; Masaomi Hayashi; Akihiro Isotani; Nobuhisa Ohno; Shinichi Kakumoto; Kenji Ando

doi:10.1016/j.jacasi.2023.09.004

Assessing Potential Risks of Future Redo Transcatheter Aortic Valve Replacement in Asian Patients

JACC Asia. 2023 Oct 31;4(1):25-39. doi: 10.1016/j.jacasi.2023.09.004. eCollection 2024 Jan.

Authors

Norihisa Miyawaki¹, Kenichi Ishizu¹, Shinichi Shirai¹, Kenji Nakano¹, Tadatomo Fukushima¹, Euihong Ko¹, Yasuo Tsuru¹, Hiroaki Tashiro¹, Miho Nakamura¹, Hiroyuki Tabata¹, Toru Morofuji¹, Takashi Morinaga¹, Masaomi Hayashi¹, Akihiro Isotani¹, Nobuhisa Ohno², Shinichi Kakumoto³, Kenji Ando¹

Affiliations

¹ Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
² Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan.
³ Department of Anesthesiology, Kokura Memorial Hospital, Kitakyushu, Japan.

Abstract

Background: In the Asian cohort, data are limited on the risk for coronary obstruction due to sinus of Valsalva (SOV) sequestration in redo transcatheter aortic valve replacement (TAVR) procedures.

Objectives: The aim of this study was to assess the potential risk for coronary obstruction in simulated redo TAVR in Asian patients.

Methods: Post-TAVR computed tomographic data from 788 patients who received balloon-expandable (BE) SAPIEN 3 transcatheter aortic valves (TAVs) and 334 patients who received self-expanding (SE) Evolut R or Evolut PRO TAVs were analyzed. The risk for coronary obstruction due to SOV sequestration in redo TAVR, defined as the TAV commissure level above the sinotubular junction (STJ) and a TAV-to-STJ distance <2.0 mm in each coronary sinus, was retrospectively evaluated.

Results: The potential risks for coronary obstruction due to SOV sequestration at 1 or both coronary arteries were identified in 52.1% of the BE TAV group and 71.3% of the SE TAV group (P < 0.001). After adjusting for multiple covariates, STJ diameter, STJ height, TAV oversizing degree by area, and implantation depth were independently associated with SOV sequestration risk in the BE TAV group, whereas STJ diameter and implantation depth were independently associated with SOV sequestration risk in the SE TAV group.

Conclusions: Coronary obstruction due to SOV sequestration in redo TAVR may occur in a substantial number of Asian patients. This finding suggests the importance of considering the structural feasibility of future redo TAVR when implanting the first TAV, especially in Asian patients with long life expectancy.

Keywords: aortic stenosis; computed tomography; sinus sequestration; structural heart disease; transcatheter aortic valve replacement.