Nicolas M. Van Mieghem

Background Preprocedural computed tomography planning improves procedural safety and efficacy of transcatheter aortic valve implantation (TAVI). However, contemporary imaging modalities do not account for device‐host interactions. Aims This study evaluates the value of preprocedural computer simulation with FEops HEARTguide TM on overall device success in patients with challenging anatomies undergoing TAVI with a contemporary self‐expanding supra‐annular transcatheter heart valve. Methods This prospective multicenter observational study included patients with a challenging anatomy defined as bicuspid aortic valve, small annulus or severely calcified aortic valve. We compared the heart team's transcatheter heart valve (THV) planning decision based on (1) conventional multislice computed tomography (MSCT) and (2) MSCT imaging with FEops HEARTguide TM simulations. Clinical outcomes and THV performance were followed up to 30 days. Results A total of 77 patients were included (median age 79.9 years (IQR 74.2–83.8), 42% male). In 35% of the patients, preprocedural planning changed after FEops HEARTguide TM simulations (change in valve size selection [12%] or target implantation height [23%]). A new permanent pacemaker implantation (PPI) was implanted in 13% and >trace paravalvular leakage (PVL) occurred in 28.5%. The contact pressure index (i.e., simulation output indicating the risk of conduction abnormalities) was significantly higher in patients with a new PPI, compared to those without (16.0% [25th–75th percentile 12.0–21.0] vs. 3.5% [25th–75th percentile 0–11.3], p < 0.01) The predicted PVL was 5.7 mL/s (25th–75th percentile 1.3–11.1) in patients with none‐trace PVL, 12.7 (25th–75th percentile 5.5–19.1) in mild PVL and 17.7 (25th–75th percentile 3.6–19.4) in moderate PVL ( p = 0.04). Conclusion FEops HEARTguide TM simulations may provide enhanced insights in the risk for PVL or PPI after TAVI with a self‐expanding supra‐annular THV in complex anatomies.

Objectives To evaluate the stent expansion of the durable‐polymer Zotarolimus‐eluting stent (dp‐ZES), the durable‐polymer Everolimus‐eluting stent (dp‐EES), and the bioabsorbable‐polymer Sirolimus‐eluting stent (bp‐SES) in calcified coronary chronic total occlusions (CTO). Background The newer generation stents with ultrathin struts might raise concerns regarding reduced radial strength and higher stent recoil (SR) when implanted in calcified CTOs. Methods Between January 2017 and June 2021 consecutive patients with CTO undergoing percutaneous coronary intervention with dp‐ZES, dp‐EES, or bp‐SES were evaluated. The analysis was performed in calcific and in noncalcific CTOs. Quantitative coronary angiography analysis was used to assess diameter stenosis (DS), absolute and relative SR, absolute and relative focal SR, absolute and relative balloon deficit (BD), and absolute and relative focal BD. The primary endpoint was DS. Results A total of 213 CTOs were evaluated, 115 calcific CTOs (dp‐ZES:25, dp‐EES:29, bp‐SES:61) and 98 non‐calcific CTOs (dp‐ZES:41, dp‐EES:11, bp‐SES:46). In calcific CTOs, residual DS was lower in dp‐ZES than in dp‐EES and bp‐SES (−1.00% [−6.50–6.50] vs. 13.00% [7.0–19.00] vs. 15.00% [5.00–20.00]; p < 0.001). Dp‐ZES was also an independent predictor of residual DS ≤ 10% (OR 11.34, 95% CI 2.6–49.43, p = 0.001). Absolute and relative focal SR and absolute and relative SR were similar between dp‐ZES, dp‐EES, and bp‐SES ( p = 0.913, p = 0.890, p = 0.518, p = 0.426, respectively). In noncalcified CTOs, the residual DS was similar in the three groups ( p = 0.340). High relative focal SR was less frequent in dp‐ZES than in dp‐EES and in bp‐SES (19.5% vs. 54.5% vs. 37.0%; p < 0.048). Conclusions The three stent platforms demonstrated an overall low residual DS when implanted in CTOs. However, dp‐ZES was associated with the lowest residual DS and identified as independent predictor of residual DS ≤ 10% in patients with calcific CTOs. Dp‐ZES was associated with a lower incidence of high relative focal stent recoil, in noncalcific CTOs. Balloon deficit might be considerate as a surrogate for stent expansion in calcified CTOs.