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A computed tomography study of coronary access and coronary obstruction after redo transcatheter aortic valve implantation

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  • Nicola Buzzatti
  • Matteo Montorfano
  • Vittorio Romano
  • Ole De Backer
  • Lars Søndergaard
  • Liesbeth Rosseel
  • Pal Maurovich-Horvat
  • Julia Karady
  • Béla Merkely
  • Bernard D Prendergast
  • Michele De Bonis
  • Antonio Colombo
  • Azeem Latib
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AIMS: The aim of this study was to investigate the risk of impaired coronary access and coronary obstruction after redo TAVI.

METHODS AND RESULTS: Post-procedure multidetector computed tomography (MDCT) scans of 221 TAVI recipients were analysed. Increased risk of impaired coronary access was defined as a coronary ostium below the TAVI commissures with a valve-to-aorta distance <2 mm at this level. Increased risk was found in 123 (55.6%) cases: the left main was involved in 109 (49.3%), the right coronary in 79 (35.7%), and both were involved in 65 (29.4%) patients. A small sinotubular junction (STJ width OR 0.68, CI: 0.56-0.81, p<0.001; STJ height OR 0.81, CI: 0.69-0.95, p<0.011) and supra-annular devices (OR 19.8, CI: 6.6-58.8, p<0.001) predicted increased risk. Increased risk of coronary obstruction, defined as a coronary ostium below the TAVI commissures with a valve-to-coronary distance <2 mm, was observed in 14.9% of patients; in 17.2% of cases complete sealing of the STJ would occur.

CONCLUSIONS: Post-TAVI MDCT suggested an increased potential risk of impaired coronary access in more than half of the patients should redo TAVI be required, predicted by a small STJ and supra-annular device design. Furthermore, 10-20% of patients presented an increased risk of coronary obstruction. While this theoretical study is hypothesis-generating, it raises concerns that need to be further investigated and addressed before TAVI is extended to patients with longer life expectancy. Visual summary. Aortic root in native anatomy (A), after TAVI (B) and after redo TAVI (C): small sinotubular junction and high leaflets of the transcatheter heart valve, pushed up and outwards by the second device, are associated with impaired coronary access and perfusion after redo TAVI.

Original languageEnglish
JournalEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Volume16
Issue number12
Pages (from-to)e1005-e1013
ISSN1774-024X
DOIs
Publication statusPublished - 18 Dec 2020

    Research areas

  • Aortic Valve/diagnostic imaging, Aortic Valve Stenosis/diagnostic imaging, Coronary Occlusion, Heart Valve Prosthesis, Humans, Multidetector Computed Tomography, Prosthesis Design, Transcatheter Aortic Valve Replacement/adverse effects

ID: 62240781