Evolut Self-Expanding Transcatheter Aortic Valve Replacement in Patients with Extremely Horizontal Aorta (Aortic Root Angle = 70 degrees) Technical Aspects and Clinical Outcomes

Umihiko Kaneko; Daisuke Hachinohe; Ken Kobayashi; Hidemasa Shitan; Keijiro Mitsube; Azusa Furugen; Takeshi Kawamura; Ryuji Koshima; Tsutomu Fujita

doi:10.1536/ihj.20-120

Back

Evolut Self-Expanding Transcatheter Aortic Valve Replacement in Patients with Extremely Horizontal Aorta (Aortic Root Angle = 70 degrees) Technical Aspects and Clinical Outcomes

Journal article

Open access

Peer reviewed

Evolut Self-Expanding Transcatheter Aortic Valve Replacement in Patients with Extremely Horizontal Aorta (Aortic Root Angle = 70 degrees) Technical Aspects and Clinical Outcomes

Umihiko Kaneko, Daisuke Hachinohe, Ken Kobayashi, Hidemasa Shitan, Keijiro Mitsube, Azusa Furugen, Takeshi Kawamura, Ryuji Koshima and Tsutomu Fujita

International heart journal, Vol.61(5), pp.1059-1069

09/29/2020

DOI: 10.1536/ihj.20-120

PMID: 32921666

Files and links (1)

url

https://doi.org/10.1536/ihj.20-120View

Published (Version of record) Open Access

Abstract

Because of its rigidity and non-steerability, the presence of a horizontal aortic root poses a major anatomical issue during transcatheter aortic valve replacement (TAVR) with Evolut self-expanding valve. Previous studies have elucidated the difficulties of coaxial implantation of the self-expanding valve in patients with horizontal aorta, often resulting in increased complications and a lower device success rate. To date, most patients with extremely horizontal aorta (aortic root angle >= 70 degrees) have been excluded from major TAVR clinical trials. Therefore, available data on TAVR with Evolut in this challenging anatomy are limited, and standardized treatment strategies and clinical results remain unknown. Herein. we report a clinical case series of TAVR with Evolut in extremely horizontal aorta. Among seven patients (aged 80-92 years; STS score, 12.6% +/- 7.9%) who underwent TAVR with Evolut system, aortic root angle ranged from 71 degrees to 83 degrees (mean. 75.1 degrees +/- 4.5 degrees). All patients achieved device success with dedicated strategies and were clinically stable at 3-month follow-up. None of the patients had more than mild paravalvular leakage (PVL) at any point during follow-up. Complications in three patients included complete atrioventricular block requiring a permanent pacemaker implantation, cerebral infarction because of atrial fibrillation 3 days after TAVR, and cardiac tamponade requiring pericardiocentesis. In this case series, Evolut self-expanding TAVR in extremely horizontal aorta was effective and feasible with a high device success rate. Bast-xi on anatomical features, some dedicated strategies majorly contribute to the success of this procedure. Large-scale multicenter studies are required to confirm our findings.

Cardiac & Cardiovascular Systems

Cardiovascular System & Cardiology

Life Sciences & Biomedicine

Science & Technology

Details

Title: Subtitle: Evolut Self-Expanding Transcatheter Aortic Valve Replacement in Patients with Extremely Horizontal Aorta (Aortic Root Angle = 70 degrees) Technical Aspects and Clinical Outcomes
Creators: Umihiko Kaneko - Sapporo Science Center
Daisuke Hachinohe - Sapporo Science Center
Ken Kobayashi - Sapporo Science Center
Hidemasa Shitan - Sapporo Science Center
Keijiro Mitsube - Sapporo Science Center
Azusa Furugen - Sapporo Science Center
Takeshi Kawamura - Sapporo Science Center
Ryuji Koshima - Sapporo Science Center
Tsutomu Fujita - Sapporo Science Center
Resource Type: Journal article
Publication Details: International heart journal, Vol.61(5), pp.1059-1069
DOI: 10.1536/ihj.20-120
PMID: 32921666
NLM abbreviation: Int Heart J
ISSN: 1349-2365
eISSN: 1349-3299
Publisher: Int Heart Journal Assoc
Number of pages: 11
Language: English
Date published: 09/29/2020
Academic Unit: Anesthesia
Record Identifier: 9985014848502771

Metrics

4 Record Views

See more details