Risk Of Coronary Obstruction In Redotranscatheter Aortic Valve Replacement Between Bicuspid And Tricuspid Aortic Valves Atsushi Okada Md Phd Syed Zaid Md Miho Fukui Md Phd Evan Walserkuntz Ms Larissa I Stanberry Phd Marcus R Burns Dnp John R Lesser Md João L Cavalcante Md Paul Sorajja Md Vinayak N Bapat Md by Atsushi Okada Md Phd & Syed Zaid Md & Miho Fukui Md Phd & Evan Walser-kuntz Ms & Larissa I. Stanberry Phd & Marcus R. Burns Dnp & John R. Lesser Md & João L. Cavalcante Md & Paul Sorajja Md & Vinayak N. Bapat Md instant download after payment.

BACKGROUND Transcatheter aortic valve replacement (TAVR) is approved across all risk profiles, including patientswith bicuspid aortic valves. These patients are generally younger, with a higher chance of reintervention.OBJECTIVES The aim of this study was to compare the feasibility of redo transcatheter aortic valve (TAV) betweenbicuspid and tricuspid aortic valves.METHODS A computed tomographic (CT) simulation of redo-TAV was conducted using 913 post-TAVR CT studies frompatients who underwent TAVR with SAPIEN 3 or SAPIEN 3 Ultra (S3; n ¼ 623) or Evolut R, Evolut PRO, or Evolut PROþ(Evolut; n ¼ 290) valves. Fifty-nine cases were for bicuspid valves. Four redo-TAV scenarios—S3-in-S3, Evolut-in-S3, S3-in-Evolut, and Evolut-in-Evolut—were simulated. Second TAV size was determined from the averaged stent areas in thelanding zone, except for Evolut-in-Evolut, for which same size was simulated. Redo-TAV feasibility (risk to coronaryarteries) was estimated by the relationship between neoskirt plane and coronary risk plane or sinotubular junction and thenarrowest valve-to-aorta distances.RESULTS Patients with bicuspid valves, compared with those with tricuspid valves, were younger with lower surgicalrisk and had larger annular areas (522 mm2 [Q1-Q3: 461-597 mm2] vs 479 mm2 [Q1-Q3: 416-551 mm2]), sinus of Valsalvadiameters (34 mm [Q1-Q3: 31-36 mm] vs 32 mm [Q1-Q3: 30-35 mm]), and sinotubular junction diameters (30 mm [Q1-Q3:28-33 mm] vs 29 mm [Q1-Q3: 27-31 mm]) (P < 0.05 for all). Narrowest valve-to-aorta distances were longer in bicuspidcases, resulting in higher redo-TAV feasibility for S3-in-S3 and Evolut-in-S3 scenarios. Similar trends were observed forS3-in-Evolut and Evolut-in-Evolut, for which the feasibility tended to be higher in bicuspid cases.CONCLUSIONS Redo-TAV simulation using post-TAVR CT imaging performed at 30 days suggested higher redoTAV feasibility in patients with bicuspid aortic valves compared with tricuspid aortic valves. (JACC Cardiovasc Interv.2025;18:1174–1185) © 2025 by the American College of Cardiology Foundation.