The new valve Evolut FX has shown better commissural alignment vs. its predecessor Evolut Pro+. Prior studies have already shown commissure alignment facilitates post TAVR coronary access.
The aim of this study was to assess the capacity for coronary cannulation after TAVR using Evolut FX with adequately positioned golden markers (aligned commissures). It also looked at the impact of commissural and coronary alignment with coronary CT.
This was a multicenter study carried out in centers of US and Japan including consecutive patients with severe aortic stenosis implanted with the Evolut FX, receiving coronary angiogram and CT immediately after procedure.
A total of 126 patients were included, mean age 81. Success cannulation rate of the left coronary (within the first 10 minutes) was 100%, while the right coronary reached 96.7%.
Read also: TRISCEND II: Transcatheter Replacement vs. Medical Treatment for Tricuspid Regurgitation.
At post implantation CT, most cases presented correct commissural alignment, though 25.4% showed mild misalignment. Anatomical factors associated with failed cannulation were evaluated and left main height and left commissural misalignment were identified as the main causes. On the other hand, predictors of failed right coronary artery cannulation were Valsalva sinuses width and commissural misalignment.
Presented by Yohei Ohno at Top Late-Breaking Trials, PCR London Valves, November 24, 2024, London, Great Britain.
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