A Coronary-Friendly Device Mitigating Risk of Coronary Obstruction in Transcatheter Aortic Valve Replacement

Yuntao Lu,1,2,* Minyan Yin,3,4,* Ye Yang,1,2,* Wenshuo Wang,1,2 Lili Dong,5 Xue Yang,3,4 Chunsheng Wang,1,2 Xiaolin Wang,3,4 Jinmiao Chen,1,2 Lai Wei1,2 1Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Shanghai Engineering Research Center of Heart Valve, Shanghai, People’s Republic of China; 3Shanghai Institute of Medical Imaging, Shanghai, People’s Republic of China; 4Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 5Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lai Wei; Jinmiao Chen, Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China, Tel +86 021 64041990, Email [email protected]; [email protected]: Transcatheter aortic valve replacement (TAVR) induced coronary artery obstruction (CAO) is a rare but devastating complication. Current preventive strategies need additional procedures and may be associated with adverse events. This study aimed to evaluate the early safety and efficacy of stand-alone TAVR using the J-Valve (Jianshi JieCheng Medical Technology Co. Ltd, Shanghai, China) in patients at potential high risk for CAO.Patients and Methods: CAO was defined as coronary ostia obstruction requiring intervention. Patients at potential high risk for CAO were identified retrospectively from 673 consecutive patients who underwent TAVR from January 2015 to July 2021 at Zhongshan Hospital, Fudan University. Procedural results and early outcomes were evaluated according to Valve Academic Research Consortium-3 definitions.Results: A total of 20 consecutive patients (age 72 ± 9 years; 85% female;) were included. The Society of Thoracic Surgeons-Predicted Risk of Mortality was 5% (interquartile range, 4 to 10%). All patients (100%) had at least 2 classical risk factors for CAO by pre-procedural computed tomography analysis, and 90% patients had native aortic valve diseases. TAVR was successful in 95% of cases, with only 1 patient requiring second device implantation. Early safety at 30 days was achieved in all cases without death. All patients were free from CAO, stroke or emergency reintervention. Post-procedural mean aortic valve gradient was 7 (interquartile range, 4, 12) mmHg, and none/trace or mild aortic regurgitation was present in all patients.Conclusion: Stand-alone TAVR using the J-Valve may mitigate the risk of TAVR-induced CAO. Keywords: TAVR, coronary artery obstruction, aortic regurgitation, aortic stenosis, structural heart disease