Catheterization and Cardiovascular Interventions

ORIGINAL ARTICLE - BASIC SCIENCE

Laser ablation for preventing coronary obstruction and maintaining coronary access in redo-TAVR: A proof of concept

John Brlansky MS

The DU Cardiovascular Biomechanics Laboratory, Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA

Search for more papers by this author

Dong Qiu PhD,

Dong Qiu PhD

The DU Cardiovascular Biomechanics Laboratory, Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA

Search for more papers by this author

Ali N. Azadani PhD,

Corresponding Author

Ali N. Azadani PhD

[email protected]

orcid.org/0000-0002-9769-9342

The DU Cardiovascular Biomechanics Laboratory, Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA

Correspondence Ali N. Azadani, PhD, The DU Cardiovascular Biomechanics Laboratory, Department of Mechanical and Materials Engineering, University of Denver, 2155 E. Wesley Ave, #439, Denver, CO 80208, USA.

Email: [email protected]

Search for more papers by this author

John Brlansky MS,

John Brlansky MS

The DU Cardiovascular Biomechanics Laboratory, Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA

Search for more papers by this author

Dong Qiu PhD,

Dong Qiu PhD

The DU Cardiovascular Biomechanics Laboratory, Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA

Search for more papers by this author

Ali N. Azadani PhD,

Corresponding Author

Ali N. Azadani PhD

[email protected]

orcid.org/0000-0002-9769-9342

The DU Cardiovascular Biomechanics Laboratory, Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA

Email: [email protected]

Search for more papers by this author

First published: 27 August 2024

https://doi.org/10.1002/ccd.31197

Citations: 1

Share a link

Email
Wechat
Bluesky

Abstract

Background

Redo-transcatheter aortic valve replacement (TAVR) is a promising treatment for transcatheter aortic valve degeneration, becoming increasingly relevant with an aging population. In redo-TAVR, the leaflets of the initial (index) transcatheter aortic valve (TAV) are displaced vertically when the second TAV is implanted, creating a cylindrical cage that can impair coronary cannulation and flow. Preventing coronary obstruction and maintaining coronary access is essential, especially in young and low-risk patients undergoing TAVR. This study aimed to develop a new leaflet modification strategy using laser ablation to prevent coronary obstruction and facilitate coronary access after repeat TAVR.

Methods

To evaluate the feasibility of the leaflet modification technique using laser ablation, the initial phase of this study involved applying a medical-grade ultraviolet laser for ablation through pericardial tissue. Following this intervention, computational fluid dynamics simulations were utilized to assess the efficacy of the resulting perforations in promoting coronary flow. These simulations played a crucial role in understanding the impact of the modifications on blood flow patterns, ensuring these changes would facilitate the restoration of coronary circulation.

Results

Laser ablation of pericardium leaflets was successful, demonstrating the feasibility of creating openings in the TAV leaflets. Flow simulation results show that ablation of index valve leaflets can effectively mitigate the flow obstruction caused by sinus sequestration in redo-TAVR, with the extent of restoration dependent on the number and location of the ablated openings.

Conclusions

Laser ablation could be a viable method for leaflet modification in redo-TAVR, serving as a new tool in interventional procedures.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supporting Information

REFERENCES

1Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019; 380(18): 1695-1705.
10.1056/NEJMoa1814052
PubMed Web of Science® Google Scholar
2Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019; 380(18): 1706-1715.
10.1056/NEJMoa1816885
PubMed Web of Science® Google Scholar
3Unbehaun A, Abdullah M, Hooda A, et al. TAVR–From inoperable to younger, lower-risk patients: a slippery slope? Prog Cardiovasc Dis. 2022; 72: 41-53.
10.1016/j.pcad.2022.04.001
PubMed Google Scholar
4Forrestal BJ, Case BC, Yerasi C, et al. Risk of coronary obstruction and feasibility of coronary access after repeat transcatheter aortic valve replacement with the self-expanding evolut valve: a computed tomography simulation study. Circ Cardiovasc Interv. 2020; 13(12):e009496.
10.1161/CIRCINTERVENTIONS.120.009496
PubMed Web of Science® Google Scholar
5Nai Fovino L, Scotti A, Massussi M, et al. Coronary angiography after transcatheter aortic valve replacement (TAVR) to evaluate the risk of coronary access impairment after TAVR-in-TAVR. J Am Heart Assoc. 2020; 9(13):e016446.
10.1161/JAHA.120.016446
PubMed Web of Science® Google Scholar
6Buzzatti N, Romano V, De Backer O, et al. Coronary access after repeated transcatheter aortic valve implantation. JACC Cardiovasc Imaging. 2020; 13(2_Part_1): 508-515.
10.1016/j.jcmg.2019.06.025
PubMed Web of Science® Google Scholar
7Nai Fovino L, Scotti A, Massussi M, et al. Incidence and feasibility of coronary access after transcatheter aortic valve replacement. Catheter Cardiovasc Interv. 2020; 96(5): E535-E541.
10.1002/ccd.28720
PubMed Web of Science® Google Scholar
8Tarantini G, Fabris T, Nai Fovino L. TAVR-in-TAVR and coronary access: importance of preprocedural planning. EuroIntervention. 2020; 16(2): e129-e132.
10.4244/EIJ-D-19-01094
PubMed Web of Science® Google Scholar
9Meier D, Akodad M, Landes U, et al. Coronary access following redo TAVR. JACC Cardiovasc Interv. 2022; 15(15): 1519-1531.
10.1016/j.jcin.2022.05.005
PubMed Google Scholar
10Ochiai T, Oakley L, Sekhon N, et al. Risk of coronary obstruction due to sinus sequestration in redo transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2020; 13(22): 2617-2627.
10.1016/j.jcin.2020.09.022
PubMed Web of Science® Google Scholar
11Khan JM, Bruce CG, Babaliaros VC, Greenbaum AB, Rogers T, Lederman RJ. TAVR roulette. JACC Cardiovasc Interv. 2020; 13(6): 787-789.
10.1016/j.jcin.2019.10.010
PubMed Google Scholar
12Khan JM, Dvir D, Greenbaum AB, et al. Transcatheter laceration of aortic leaflets to prevent coronary obstruction during transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2018; 11(7): 677-689.
10.1016/j.jcin.2018.01.247
PubMed Web of Science® Google Scholar
13Khan JM, Greenbaum AB, Babaliaros VC, et al. The BASILICA trial: prospective multicenter investigation of intentional leaflet laceration to prevent TAVR coronary obstruction. JACC Cardiovasc Interv. 2019; 12(13): 1240-1252.
10.1016/j.jcin.2019.03.035
PubMed Web of Science® Google Scholar
14Pirelli L, Basman CL, Brinster DR, et al. Surgical resection of prosthetic valve leaflets under direct vision (SURPLUS) for redo TAVR. JACC Cardiovasc Interv. 2021; 14(9): 1036-1037.
10.1016/j.jcin.2021.02.026
PubMed Google Scholar
15Khan JM, Greenbaum AB, Babaliaros VC, et al. BASILICA trial: one-year outcomes of transcatheter electrosurgical leaflet laceration to prevent TAVR coronary obstruction. Circ Cardiovasc Interv. 2021; 14(5):e010238.
10.1161/CIRCINTERVENTIONS.120.010238
PubMed Web of Science® Google Scholar
16Lederman RJ, Babaliaros VC, Rogers T, et al. Preventing coronary obstruction during transcatheter aortic valve replacement: from computed tomography to BASILICA. JACC Cardiovasc Interv. 2019; 12(13): 1197-1216.
10.1016/j.jcin.2019.04.052
PubMed Web of Science® Google Scholar
17Greenbaum AB, Kamioka N, Vavalle JP, et al. Balloon-assisted BASILICA to facilitate redo TAVR. JACC Cardiovasc Interv. 2021; 14(5): 578-580.
10.1016/j.jcin.2020.10.056
PubMed Web of Science® Google Scholar
18Dvir D, Leon MB, Abdel-Wahab M, et al. First-in-human dedicated leaflet splitting device for prevention of coronary obstruction in transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2023; 16(1): 94-102.
10.1016/j.jcin.2022.10.050
PubMed Web of Science® Google Scholar
19Dvir D, Tchétché D, Leon MB, et al. Leaflet modification before transcatheter aortic valve implantation in patients at risk for coronary obstruction: the ShortCut study. Eur Heart J. 2024: 1-11. doi:10.1093/eurheartj/ehae303
PubMed Google Scholar
20Chan K-YE, Tai-Leung Chan D, Lam C-CS, et al. First-in-human undermining iatrogenic coronary obstruction with radiofrequency needle (UNICORN) procedure during valve-in-valve transcatheter aortic valve replacement. Circ Cardiovasc Interv. 2022; 15(11): 928-931.
10.1161/CIRCINTERVENTIONS.122.012399
PubMed Web of Science® Google Scholar
21Berne RM. Cardiovascular physiology. Annu Rev Physiol. 1981; 43(1): 357-358.
10.1146/annurev.ph.43.030181.002041
Google Scholar
22Vahidkhah K, Cordasco D, Abbasi M, et al. Flow-induced damage to blood cells in aortic valve stenosis. Ann Biomed Eng. 2016; 44: 2724-2736.
10.1007/s10439-016-1577-7
PubMed Web of Science® Google Scholar
23Iung B. A prospective survey of patients with valvular heart disease in Europe: the euro heart survey on valvular heart disease. Eur Heart J. 2003; 24(13): 1231-1243.
10.1016/S0195-668X(03)00201-X
PubMed Web of Science® Google Scholar
24Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. The Lancet. 2006; 368(9540): 1005-1011.
10.1016/S0140-6736(06)69208-8
PubMed Web of Science® Google Scholar
25Takkenberg JJ, Rajamannan NM, Rosenhek R, et al. The need for a global perspective on heart valve disease epidemiology. The SHVD working group on epidemiology of heart valve disease founding statement. J Heart Valve Dis. 2008; 17(1): 135-139.
PubMed Web of Science® Google Scholar
26Yacoub MH, Takkenberg JJM. Will heart valve tissue engineering change the world? Nat Clin Pract Cardiovasc Med. 2005; 2(2): 60-61.
10.1038/ncpcardio0112
CAS PubMed Google Scholar
27De Santo LS, Romano G, Della Corte A, et al. Mechanical aortic valve replacement in young women planning on pregnancy. J Am Coll Cardiol. 2012; 59(12): 1110-1115.
10.1016/j.jacc.2011.10.899
PubMed Web of Science® Google Scholar
28Faroux L, Guimaraes L, Wintzer-Wehekind J, et al. Coronary artery disease and transcatheter aortic valve replacement. J Am Coll Cardiol. 2019; 74(3): 362-372.
10.1016/j.jacc.2019.06.012
PubMed Web of Science® Google Scholar
29Rapp AH, Hillis LD, Lange RA, Cigarroa JE. Prevalence of coronary artery disease in patients with aortic stenosis with and without angina pectoris. Am J Cardiol. 2001; 87(10): 1216-1217.
10.1016/S0002-9149(01)01501-6
CAS PubMed Web of Science® Google Scholar
30Kotronias RA, Kwok CS, George S, et al. Transcatheter aortic valve implantation with or without percutaneous coronary artery revascularization strategy: a systematic review and meta-analysis. J Am Heart Assoc. 2017; 6(6):e005960.
10.1161/JAHA.117.005960
PubMed Web of Science® Google Scholar
31Tarantini G, Sathananthan J, Fabris T, et al. Transcatheter aortic valve replacement in failed transcatheter bioprosthetic valves. JACC Cardiovasc Interv. 2022; 15(18): 1777-1793.
10.1016/j.jcin.2022.07.035
PubMed Web of Science® Google Scholar
32Ribeiro HB, Rodés-Cabau J, Blanke P, et al. Incidence, predictors, and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: insights from the VIVID registry. Eur Heart J. 2018; 39(8): 687-695.
10.1093/eurheartj/ehx455
PubMed Web of Science® Google Scholar
33Jabbour RJ, Tanaka A, Finkelstein A, et al. Delayed coronary obstruction after transcatheter aortic valve replacement. J Am Coll Cardiol. 2018; 71(14): 1513-1524.
10.1016/j.jacc.2018.01.066
PubMed Web of Science® Google Scholar
34Azadani A, Brlansky J. TCT-509 laser ablation: a new leaflet modification strategy to prevent coronary obstruction in TAVR-in-TAVR. J Am Coll Cardiol. 2022; 80(12_suppl ment): B207B207.
Google Scholar
35Taylor KD, Reiser C. From laser physics to clinical utilization: design and ablative properties of cardiovascular laser catheters. In: O Topaz, ed. Lasers in Cardiovascular Interventions. Springer; 2015; 1-14. doi:10.1007/978-1-4471-5220-0_1
Google Scholar
36Egred M, Brilakis ES. Excimer laser coronary angioplasty (ELCA): fundamentals, mechanism of action, and clinical applications. J Invasive Cardiol. 2020; 32(2): E27-E35.
10.25270/jic/19.00325
PubMed Web of Science® Google Scholar
37Knappe V, Frank F, Rohde E. Principles of lasers and biophotonic effects. Photomed Laser Surg. 2004; 22(5): 411-417.
10.1089/pho.2004.22.411
PubMed Web of Science® Google Scholar
38Topaz O, Das T, Dahm J, Madyhoon H, Perin E, Ebersole D. Excimer laser revascularisation: current indications, applications and techniques. Lasers Med Sci. 2001; 16: 72-77.
10.1007/PL00011345
CAS PubMed Web of Science® Google Scholar
39Vahidkhah K, Barakat M, Abbasi M, et al. Valve thrombosis following transcatheter aortic valve replacement: significance of blood stasis on the leaflets. Eur J Cardiothorac Surg. 2017; 51(5):ezw407.
10.1093/ejcts/ezw407
Google Scholar
40Vahidkhah K, Javani S, Abbasi M, et al. Blood stasis on transcatheter valve leaflets and implications for valve-in-valve leaflet thrombosis. Ann Thorac Surg. 2017; 104(3): 751-759.
10.1016/j.athoracsur.2017.02.052
PubMed Web of Science® Google Scholar
41Midha PA, Raghav V, Sharma R, et al. The fluid mechanics of transcatheter heart valve leaflet thrombosis in the neosinus. Circulation. 2017; 136(17): 1598-1609.
10.1161/CIRCULATIONAHA.117.029479
PubMed Web of Science® Google Scholar
42Hatoum H, Dollery J, Lilly SM, Crestanello JA, Dasi LP. Implantation depth and rotational orientation effect on valve-in-valve hemodynamics and sinus flow. Ann Thorac Surg. 2018; 106(1): 70-78.
10.1016/j.athoracsur.2018.01.070
PubMed Web of Science® Google Scholar
43Trusty PM, Bhat SS, Sadri V, et al. The role of flow stasis in transcatheter aortic valve leaflet thrombosis. J Thorac Cardiovasc Surg. 2020; 164(3): e105-e117.
10.1016/j.jtcvs.2020.10.139
PubMed Google Scholar

Citing Literature

Volume104, Issue5

November 1, 2024

Pages 1086-1095

SCAI Member Sign in

Filename	Description
ccd31197-sup-0001-Supplementary_Material.docx13.2 KB	Supporting information.
ccd31197-sup-0002-Video_1_reduced_resolution.mp41.3 MB	Supporting information.

Laser ablation for preventing coronary obstruction and maintaining coronary access in redo-TAVR: A proof of concept

Abstract

Background

Methods

Results

Conclusions

CONFLICT OF INTEREST STATEMENT

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Laser ablation for preventing coronary obstruction and maintaining coronary access in redo-TAVR: A proof of concept

Abstract

Background

Methods

Results

Conclusions

CONFLICT OF INTEREST STATEMENT

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

Citing Literature

References

Related

Information