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. 2020 Nov 23;13(22):2617-2627.
doi: 10.1016/j.jcin.2020.09.022.

Risk of Coronary Obstruction Due to Sinus Sequestration in Redo Transcatheter Aortic Valve Replacement

Tomoki Ochiai  1 , Luke Oakley  2 , Navjot Sekhon  2 , Ikki Komatsu  3 , Nir Flint  4 , Danon Kaewkes  5 , Sung-Han Yoon  2 , Matthias Raschpichler  6 , Vivek Patel  2 , Ripandeep Tiwana  2 , Yusuke Enta  2 , Sahar Mahani  2 , Yisik Kim  7 , Jasminka Stegic  2 , Tarun Chakravarty  2 , Mamoo Nakamura  2 , Wen Cheng  2 , Raj Makkar  8
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Free article

Risk of Coronary Obstruction Due to Sinus Sequestration in Redo Transcatheter Aortic Valve Replacement

Tomoki Ochiai et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: The aim of this study was to evaluate the risk of coronary obstruction due to sinus sequestration in redo transcatheter aortic valve replacement (TAVR) using post-TAVR computed tomography (CT).

Background: Little information is available regarding the risk of coronary obstruction due to sinus sequestration in redo TAVR inside a previously implanted TAV.

Methods: Post-TAVR CT of 66 patients who received an Evolut R or Evolut PRO and 345 patients who received a SAPIEN 3 were analyzed. Redo TAVR was considered at risk of coronary obstruction due to sinus sequestration if: 1) the prior TAV commissure level was above sinotubular junction (STJ); and 2) the distance between TAV and STJ was <2.0 mm in each coronary sinus.

Results: In total, 45.5% in the Evolut R/Evolut PRO group and 2.0% in the SAPIEN 3 group had CT-identified risk of sinus sequestration at 1 or both coronary arteries (p < 0.001). CT-identified risk of sinus sequestration was observed in 39.4% for the left coronary artery and 24.2% for the right coronary artery in the Evolut R/Evolut PRO group, while those percentages were 2.0% for the left coronary artery and 0.6% for the right coronary artery in the SAPIEN 3 group. In a coronary-level analysis, overlaps between the first TAV commissural posts and coronary ostium were observed in 45.2% in the Evolut R/Evolut PRO group and 11.1% in in the SAPIEN 3 group among coronary arteries at CT-identified risk of sinus sequestration.

Conclusions: The risk of sinus sequestration in redo TAVR should be carefully screened by CT, especially in patients with low STJ height. TAV with low commissure height that was designed to achieve commissure-to-commissure alignment with the native aortic valves may be preferable to avoid the risk of coronary obstruction due to sinus sequestration and allow for a preventive leaflet laceration procedure in future redo TAVR. (Assessment of TRanscathetEr and Surgical Aortic BiOprosthetic Valve Thrombosis and Its TrEatment With Anticoagulation [RESOLVE]; NCT02318342).

Keywords: BASILICA; coronary obstruction; durability; transcatheter aortic valve replacement; valve-in-valve.

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Conflict of interest statement

Author Relationship with Industry This work was supported by the Smidt Heart Institute at Cedars-Sinai Medical Center. Dr. Chakravarty has served as a speaker and consultant for Edwards Lifesciences, Boston Scientific, Medtronic, and Abbott. Dr. Makkar has received grant support from Edwards Lifesciences; has served as a consultant for Abbott Vascular, Cordis, and Medtronic; and owns equity in Entourage Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

  • Redo-TAVR: What About the Coronary Arteries?
    De Backer O, Søndergaard L. De Backer O, et al. JACC Cardiovasc Interv. 2020 Nov 23;13(22):2628-2630. doi: 10.1016/j.jcin.2020.10.005. JACC Cardiovasc Interv. 2020. PMID: 33213748 No abstract available.

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