Coronary Cannulation Following Transcatheter Aortic Valve Replacement With Self-Expanding Evolut FX+ System: The CANNULATE TAVR II Study

Abstract

•The CANNULATE TAVR II is the first prospective study evaluating coronary cannulation following implantation of the self-expanding Evolut FX+ valve, offering a direct comparison with patients treated using the previous-generation Evolut FX platform.•A novel geometric analysis using preprocedural and postprocedural computed tomography imaging was introduced to assess the spatial relationship between valve apertures and coronary ostia, incorporating the left coronary artery-right coronary artery angle and coronary height differences.•Mean time for the cannulation of the right coronary artery was faster with the newer Evolut FX+ platform compared to the previous generation, despite an experienced operator performing the procedures.•Despite approximately half of the coronaries not being within the apertures of the newer Evolut FX+ platform after post-transcatheter aortic valve replacement computed tomography-scan analysis, a successful coronary cannulation was obtained in 100% of the cases using the same approach as the prior generation, and no modifications were implemented to ensure that the apertures were co-axial with the coronaries.

Keywords: Cannulation; Evolut FX+; TAVR.

Figure 1

Panel (a): Mathematic equation for predicting the possibility of alignment between the apertures and coronary ostia. Panel (b): Predicted possibility of alignment between apertures and coronary ostia based on LCA-RCA angle ranges and LCA-RCA height difference for the four valve sizes based on the Evolut FX+ cohort. Panel (c): Simulation-based possibility of alignment between left and right apertures with left main and right coronary artery in the Evolut FX+ population. Panel (d): Final postprocedural position and alignment of the apertures and coronary ostia. Abbreviations: LCA, left coronary artery; RCA, right coronary artery.