Risk of Sinus Sequestration During Redo Transcatheter Aortic Valve Implantation: The Prevalence, Predictors, and Risk Stratification

Abstract

The number of patients undergoing transcatheter aortic valve implantation (TAVI) with the potential for re-intervention is steadily increasing; however, there is a risk of sinus sequestration (SS) during a redo TAVI. The prevalence, predictors, and risk stratification of risk for SS remain uncertain. We analyzed computed tomography acquired from 263 patients who underwent TAVI between 2021 and 2022: balloon-expandable valve (BEV), 71%, and self-expandable valve (SEV), 29%. Patients were considered at risk of SS if they met 1) BEV frame > sino-tubular junction (STJ) or SEV neo-commissure > STJ and 2) valve-to-STJ < 2 mm. The risk of left, right, and any SS in 51%, 50%, and 65%, respectively, which did not differ between BEV and SEV. The predictors of any SS were the height of the left and right coronary cusp (Odds ratio [OR], 0.81 and 0.71; cut-off, 18.6 and 19.2 mm) and STJ minus annulus diameter (OR, 0.65; cut-off, 3.7 mm) in BEV, and STJ diameter (OR, 0.47; cut-off, 27.6 mm) in SEV. The number of predictors stratified the risk of any SS: low risk with BEV, at 0 predictors (14% at risk of SS); intermediate risk, 1 predictor (65%); high risk, 2 or 3 predictors (81% and 95%); low risk with SEV, 0 predictors (33%), vs. high risk, 1 predictor (91%). In conclusion, two-thirds of patients undergoing TAVI were at risk of SS. The height of the coronary cusp and the STJ diameter were associated with, and adequately stratified the risk of SS.