Differences in Coronary Alignment Between Evolut FX and Navitor Valves.

BACKGROUND: Ensuring coronary access is essential for lifetime management after transcatheter aortic valve replacement (TAVR). However, the data on coronary alignment using the latest supra-annular (SA) and intra-annular (IA) self-expandable valves (SEV) are limited.

AIMS: This study evaluated coronary alignment after TAVR using SA-SEV and IA-SEV using post-procedural CT images.

METHODS: This retrospective study analyzed TAVR cases using the latest SA-SEV (n = 250) and IA-SEV (n = 152). Coronary overlap (CO) was assessed by measuring the angle between the neo-commissure and coronary ostium. Coronary geometry was evaluated by the vertical distance from the coronary ostium to top of the outer skirt and the horizontal distance from the ostium to the transcatheter heart valve (THV) frame.

RESULTS: The SA-SEV was associated with significantly lower rates of severe CO than the IA-SEV in both the left (LCA) (10% vs. 42%) and right coronary arteries (RCA) (12% vs. 34%). The vertical distance from the coronary ostium to the outer skirt was shorter in SA-SEV than in IA-SEV for both arteries (LCA: 3.3 mm vs. 8.0 mm; RCA: 4.4 mm vs. 9.0 mm). Conversely, SA-SEV demonstrated a wider horizontal distance between the coronary ostium and THV frame than IA-SEV (LCA: 4.8 mm vs. 3.8 mm; RCA: 5.4 mm vs. 4.4 mm).

CONCLUSIONS: CO and ostial geometry relative to the THV frame differed significantly between the two SEV platforms. Balancing these anatomic and device-specific factors may be essential to ensure future coronary access following TAVR.