Sinus Hemodynamics after Transcatheter Aortic Valve in Transcatheter Aortic Valve

Abstract Background The objective of this study is to evaluate the effect of transcatheter aortic valve (TAV)-in-TAV on sinus hemodynamics and washout. With TAV becoming the standard procedure for aortic valve replacement and with the limited valve durability, a second intervention is necessary (TAV-in-TAV) after first TAV failure. Methods Six arrangements of TAV-in-TAV were chosen for this study as follows: (1) Evolut 23 in Evolut 26, (2) Evolut 23 in SAPIEN 23, (3) Evolut 26 in Evolut 26, (4) Evolut 26 in SAPIEN 23, (5) SAPIEN 23 in Evolut 26 and (6) SAPIEN 23 in SAPIEN 23. These TAV-in-TAV configurations were assessed in a pulse duplicator. Particle Image Velocimetry was performed. Results During systole, (1) the highest velocity was found with SAPIEN-in-SAPIEN (0.7m/s) and the lowest with Evolut 26-in-Evolut 26 (0.2m/s); (2) the highest shear stress magnitude near the leaflet was with Evolut 23-in-SAPIEN (1.45Pa) and the lowest with Evolut 26-in-Evolut 26 (0.55Pa); and (3) washout was almost equal in all sinuses of these cases ( Conclusions This study shows that TAV-in-TAV is highly dependent on the valve that is originally implanted and the valve be implanted. Washout is not significantly degraded after TAV-in-TAV compared with valve-in-valve (ViV) and TAV replacement (TAVR). Further studies are needed to optimize valve size and selection.