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Udgivet

Cusp Symmetry and Coronary Ostial Eccentricity and its Impact on Coronary Access Following TAVR

Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review

DOI

  1. Management and Outcome of Acute Ischemic Stroke Complicating Transcatheter Aortic Valve Replacement

    Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review

  2. Measuring Transvalvular Aortic Pressure Gradients: Answering Questions or Asking New Ones?

    Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review

  3. Transcatheter Aortic Valve Replacement in Failed Transcatheter Bioprosthetic Valves

    Publikation: Bidrag til tidsskriftReviewpeer review

  4. Coronary Access Following Redo TAVR: Impact of THV Design, Implant Technique, and Cell Misalignment

    Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review

  1. Transcatheter aortic valve-in-valve implantation to treat aortic Para-valvular regurgitation after TAVI

    Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review

  2. Management and Outcome of Acute Ischemic Stroke Complicating Transcatheter Aortic Valve Replacement

    Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review

  3. Transcatheter Aortic Valve Replacement in Failed Transcatheter Bioprosthetic Valves

    Publikation: Bidrag til tidsskriftReviewpeer review

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OBJECTIVES: The aim of this study was to assess cusp symmetry and coronary ostial eccentricity and its impact on coronary access following transcatheter aortic valve replacement (TAVR) using a patient-specific commissural alignment implantation technique.

BACKGROUND: TAVR implantation techniques to obtain neocommissural alignment have been introduced. The impact of cusp symmetry and coronary ostial eccentricity on coronary access after TAVR remains unknown.

METHODS: Cardiac computed tomographic scans from 200 tricuspid aortic valves (TAVs) and 200 type 1 bicuspid aortic valves (BAVs) were studied. Cusp symmetry and coronary ostial eccentricity were assessed. In addition, the right coronary cusp/left coronary cusp and right coronary artery (RCA)/left coronary artery (LCA) ostia overlap views were calculated and compared.

RESULTS: Severe cusp asymmetry (>135°) was more frequent in BAVs (52.5%) than in TAVs (2.5%) (P < 0.001), with the noncoronary cusp being the most common dominant cusp. The RCA ostium was found to be more often eccentric (>20°) than the LCA ostium (28% vs 6%, respectively; P < 0.001). Considering the right/left cusp overlap view, there was <20° deviation between the right coronary cusp-left coronary cusp centered line and the RCA-LCA centered line in 95% of all patients (TAV, 97%; BAV, 93%). The right/left cusp and coronary ostia overlap view differed by <10° and <20° fluoroscopic angulation in 75% and 98% of all cases, respectively.

CONCLUSIONS: Using the right/left cusp overlap view to obtain commissural alignment in TAVR is also an effective approach to implant one of the transcatheter heart valve commissures in the near center between both coronary ostia in most TAVs and type 1 BAVs. Preprocedural CT assessment remains crucial to assess cusp symmetry and coronary ostial eccentricity.

OriginalsprogEngelsk
TidsskriftJACC: Cardiovascular Interventions
Vol/bind15
Udgave nummer2
Sider (fra-til)123-134
Antal sider12
ISSN1936-8798
DOI
StatusUdgivet - 24 jan. 2022

Bibliografisk note

Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

ID: 79922516