A computed tomography study of coronary access and coronary obstruction after redo transcatheter aortic valve implantation
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A computed tomography study of coronary access and coronary obstruction after redo transcatheter aortic valve implantation. / Buzzatti, Nicola; Montorfano, Matteo; Romano, Vittorio; De Backer, Ole; Søndergaard, Lars; Rosseel, Liesbeth; Maurovich-Horvat, Pal; Karady, Julia; Merkely, Béla; Prendergast, Bernard D; De Bonis, Michele; Colombo, Antonio; Latib, Azeem.
I: EuroIntervention, Bind 16, Nr. 12, 2020, s. e1005-e1013.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - A computed tomography study of coronary access and coronary obstruction after redo transcatheter aortic valve implantation
AU - Buzzatti, Nicola
AU - Montorfano, Matteo
AU - Romano, Vittorio
AU - De Backer, Ole
AU - Søndergaard, Lars
AU - Rosseel, Liesbeth
AU - Maurovich-Horvat, Pal
AU - Karady, Julia
AU - Merkely, Béla
AU - Prendergast, Bernard D
AU - De Bonis, Michele
AU - Colombo, Antonio
AU - Latib, Azeem
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
KW - Aortic Valve/diagnostic imaging
KW - Aortic Valve Stenosis/diagnostic imaging
KW - Coronary Occlusion
KW - Heart Valve Prosthesis
KW - Humans
KW - Multidetector Computed Tomography
KW - Prosthesis Design
KW - Transcatheter Aortic Valve Replacement/adverse effects
U2 - 10.4244/EIJ-D-20-00475
DO - 10.4244/EIJ-D-20-00475
M3 - Journal article
C2 - 32928715
VL - 16
SP - e1005-e1013
JO - EuroIntervention
JF - EuroIntervention
SN - 1774-024X
IS - 12
ER -
ID: 269533528