Risk of Coronary Obstruction in Redo-Transcatheter Aortic Valve Replacement Between Bicuspid and Tricuspid Aortic Valves.

BACKGROUND

Transcatheter aortic valve replacement (TAVR) is approved across all risk profiles, including patients with bicuspid aortic valves. These patients are generally younger, with a higher chance of reintervention.

OBJECTIVES

The aim of this study was to compare the feasibility of redo transcatheter aortic valve (TAV) between bicuspid and tricuspid aortic valves.

METHODS

A computed tomographic (CT) simulation of redo-TAV was conducted using 913 post-TAVR CT studies from patients who underwent TAVR with SAPIEN 3 or SAPIEN 3 Ultra (S3; n = 623) or Evolut R, Evolut PRO, or Evolut PRO+ (Evolut; n = 290) valves. Fifty-nine cases were for bicuspid valves. Four redo-TAV scenarios-S3-in-S3, Evolut-in-S3, S3-in-Evolut, and Evolut-in-Evolut-were simulated. Second TAV size was determined from the averaged stent areas in the landing zone, except for Evolut-in-Evolut, for which same size was simulated. Redo-TAV feasibility (risk to coronary arteries) was estimated by the relationship between neoskirt plane and coronary risk plane or sinotubular junction and the narrowest valve-to-aorta distances.

RESULTS

Patients with bicuspid valves, compared with those with tricuspid valves, were younger with lower surgical risk and had larger annular areas (522 mm2 [Q1-Q3: 461-597 mm2] vs 479 mm2 [Q1-Q3: 416-551 mm2]), sinus of Valsalva diameters (34 mm [Q1-Q3: 31-36 mm] vs 32 mm [Q1-Q3: 30-35 mm]), and sinotubular junction diameters (30 mm [Q1-Q3: 28-33 mm] vs 29 mm [Q1-Q3: 27-31 mm]) (P < 0.05 for all). Narrowest valve-to-aorta distances were longer in bicuspid cases, resulting in higher redo-TAV feasibility for S3-in-S3 and Evolut-in-S3 scenarios. Similar trends were observed for S3-in-Evolut and Evolut-in-Evolut, for which the feasibility tended to be higher in bicuspid cases.

CONCLUSIONS

Redo-TAV simulation using post-TAVR CT imaging performed at 30 days suggested higher redo-TAV feasibility in patients with bicuspid aortic valves compared with tricuspid aortic valves.