Tavi After David And Yacoub Procedure With A Straight Or Sinus Prosthesis. An In Vitro Investigation.
Doreen Richardt, Sina Stock, Philipp Spiegel, Sina Heymans, Michael Scharfschwerdt, Hans-Hinrich Sievers.
University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
OBJECTIVE: Transcatheter Aortic Valve Implantation (TAVI) is an evolving treatment strategy for degenerated native and surgical aortic valve bioprostheses. It remains unclear if TAVI is feasible in patients with previous valve sparing operation (reimplantation technique, David procedure or remodelling technique, Yacoub procedure). Despite excellent hemodynamics in TAVI prostheses, there is some concern regarding fixation of the TAVI prosthesis in these patients and about coronary obstruction We sought to determine differences in coronary flow after TAVI in non-calcified aortic valves after David and Yacoub procedure with a straight or sinus prosthesis in an in vitro investigation.
METHODS: We constructed aortic root models with both, David and Yacoub procedure, performed with a straight or a sinus prosthesis and inserted a Corevalve Evolut R Medtronic or Sapien S3 Edwards TAVI prosthesis. Hemodynamic performance (transvalvular gradients and geometric orifice area) was measured before and after TAVI. Left and right coronary flow (LCF, RCF) were examined too.
RESULTS: In none of the David experiments but in all of the Yacoub experiments the TAVI-prostheses were dislocated. Therefore we performed additional stabilization of the annulus either with CV-2 Goretex suture or a ring for annuloplasty in the Yacoub model. After implementation of this measures fixation of the TAVI-prostheses after Yacoub procedure was possible. In all models, straight and sinus prosthesis as well as Corevalve Evolut R and Sapien S3 we found no significant reduction in coronary flow (all p-values non-significant). With respect to hemodynamics, TAVI resulted in no significant increase of transvalvular gradients and decrease of GOA.
CONCLUSIONS: In our in vitro David and Yacoub procedure model, TAVI with a balloon expandable transcatheter heart valve (Sapien S3) as well as a self-expanding transcatheter heart valve (Corevalve Evolut R) seems to be feasible with very good hemodynamics and no risk of coronary obstruction. After Yacoub procedure additional measures for fixation of theTAVI-prostheses in the annulus were necessary.
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