Balloon-Expandable Valve for Treatment of Evolut Valve Failure: Implications on Neoskirt Height and Leaflet Overhang.

Details

Serval ID
serval:BIB_156D25223824
Type
Article: article from journal or magazin.
Collection
Publications
Title
Balloon-Expandable Valve for Treatment of Evolut Valve Failure: Implications on Neoskirt Height and Leaflet Overhang.
Journal
JACC. Cardiovascular interventions
Author(s)
Akodad M., Sellers S., Landes U., Meier D., Tang GHL, Gada H., Rogers T., Caskey M., Rutkin B., Puri R., Rovin J., Leipsic J., Sondergaard L., Grubb K.J., Gleason P., Garde K., Tadros H., Teodoru S., Wood D.A., Webb J.G., Sathananthan J.
ISSN
1876-7605 (Electronic)
ISSN-L
1936-8798
Publication state
Published
Issued date
28/02/2022
Peer-reviewed
Oui
Volume
15
Number
4
Pages
368-377
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
This study sought to determine the degree of Evolut (Medtronic) leaflet pinning, diameter expansion, leaflet overhang, and performance at different implant depths of the balloon-expandable Sapien 3 (S3, Edwards Lifesciences LLC) transcatheter heart valve (THV) within the Evolut THV.
Preservation of coronary access and flow is a major factor when considering the treatment of failed Evolut THVs.
An in vitro study was performed with 20-, 23-, 26-, and 29-mm S3 THVs deployed within 23-, 26-, 29-, and 34-mm Evolut R THVs, respectively. The S3 outflow was positioned at various depths at node 4, 5, and 6 of the Evolut R. Neoskirt height, leaflet overhang, performance, and Evolut R valve housing diameter expansion were assessed under physiological conditions as per ISO 5840-3 standard.
The neoskirt height for the Evolut R was shorter when the S3 outflow was positioned at node 4 compared with node 6 (node 4 height for 23 mm = 16.3 mm, 26 mm = 17.1 mm, 29 mm = 18.3 mm, and 34 mm = 19.9 mm vs node 6 height for 23 mm = 23.9 mm, 26 mm = 23.4 mm, 29 mm = 24.7 mm, and 34 mm = 27 mm Evolut R). All configurations exhibited acceptable hydrodynamic performance irrespective of the degree of leaflet overhang, except the 29-mm S3 implanted in 34-mm Evolut R at node 4 (regurgitant fraction >20%). The valve housing radius of the index Evolut R increased when the S3 was implanted, with the increase ranging from 0 to 2.5 mm.
Placement of the S3 at a lower implant position within an index Evolut R reduces the neoskirt height with no significant compromise to S3 valve function despite a higher degree of leaflet overhang. Low S3 implantation may facilitate future coronary access after redo transcatheter aortic valve replacement.
Keywords
Aortic Valve/diagnostic imaging, Aortic Valve/surgery, Aortic Valve Stenosis/surgery, Heart Valve Prosthesis, Humans, Prosthesis Design, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome, aortic stenosis, bench study, redo transcatheter aortic valve replacement
Pubmed
Web of science
Open Access
Yes
Create date
17/01/2025 5:58
Last modification date
24/02/2025 11:35
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