TY - JOUR

T1 - Surgical feasibility of ascending aorta manipulation after transcatheter aortic valve implantation

T2 - A computed tomography theoretical analysis

AU - Belluschi, Igor

AU - Buzzatti, Nicola

AU - Romano, Vittorio

AU - de Backer, Ole

AU - Søndergaard, Lars

AU - Karady, Julia

AU - Maurovich-Horvat, Pal

AU - Rahgozar, Kusha

AU - de Bonis, Michele

AU - Castiglioni, Alessandro

AU - Colombo, Antonio

AU - Alfieri, Ottavio

AU - Montorfano, Matteo

AU - Latib, Azeem

N1 - Funding Information: We wish to acknowledge the Alfieri Heart Foundation for supporting data collection and analysis of this research. Publisher Copyright: © Europa Digital & Publishing 2021. All rights reserved.

PY - 2021

Y1 - 2021

N2 - Aims: The expansion of TAVI will involve an increase in the frequency of emergent or late cardiac surgery after THV implantation. This study was designed to investigate the anatomical feasibility of surgical cross-clamp and aortotomy after TAVI through a post-TAVI CT-scan assessment. Methods and results: We retrospectively analysed 117 CTs acquired after TAVI procedures with high stent prostheses in three high-volume centres between October 2008 and May 2017. The mean distance observed between the innominate artery and the top of the transcatheter heart valve was 45±11 mm, being <30 mm in 8/117 (6.8%) patients and <20 mm in none. The mean distance between the sinotubular junction and the first free site for aortotomy was 22±7 mm (>20 mm in 78/117 [66.7%] cases). A total of 56/117 (47.9%) patients showed a complete continuous contact between the anterior aortic wall and the anterior part of the valve stent. Conclusions: Aortic cross-clamp appears not to be an issue when cardiac surgery is needed after TAVI; however, a careful and possibly higher aortotomy may be required. CT should be performed prior to planned cardiac surgery after TAVI to determine a safe positioning for aortic cross-clamp and aortotomy.

AB - Aims: The expansion of TAVI will involve an increase in the frequency of emergent or late cardiac surgery after THV implantation. This study was designed to investigate the anatomical feasibility of surgical cross-clamp and aortotomy after TAVI through a post-TAVI CT-scan assessment. Methods and results: We retrospectively analysed 117 CTs acquired after TAVI procedures with high stent prostheses in three high-volume centres between October 2008 and May 2017. The mean distance observed between the innominate artery and the top of the transcatheter heart valve was 45±11 mm, being <30 mm in 8/117 (6.8%) patients and <20 mm in none. The mean distance between the sinotubular junction and the first free site for aortotomy was 22±7 mm (>20 mm in 78/117 [66.7%] cases). A total of 56/117 (47.9%) patients showed a complete continuous contact between the anterior aortic wall and the anterior part of the valve stent. Conclusions: Aortic cross-clamp appears not to be an issue when cardiac surgery is needed after TAVI; however, a careful and possibly higher aortotomy may be required. CT should be performed prior to planned cardiac surgery after TAVI to determine a safe positioning for aortic cross-clamp and aortotomy.

KW - Aortic stenosis

KW - Degenerative valve

KW - Imaging modalities

KW - MSCT

KW - TAVI

U2 - 10.4244/EIJ-D-19-00991

DO - 10.4244/EIJ-D-19-00991

M3 - Journal article

C2 - 32364502

AN - SCOPUS:85103805743

VL - 16

SP - E1533-E1540

JO - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

IS - 18

ER -