TY - JOUR
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 - Soendergaard, Lars
AU - Rosseel, Liesbeth
AU - Maurovich-Horvat, Pal
AU - Karady, Julia
AU - Merkely, Bela
AU - Prendergast, Bernard
AU - De Bonis, Michele
AU - Colombo, Antonio
AU - Latib, Azeem
N1 - Publisher Copyright:
© Europa Digital & Publishing 2020.
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.
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.
KW - Coronary artery disease
KW - Coronary occlusion
KW - TAVI
UR - http://www.scopus.com/inward/record.url?scp=85098814443&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85098814443&partnerID=8YFLogxK
U2 - 10.4244/EIJ-D-20-00475
DO - 10.4244/EIJ-D-20-00475
M3 - Article
C2 - 32928715
AN - SCOPUS:85098814443
SN - 1774-024X
VL - 16
SP - E1005-E1013
JO - EuroIntervention
JF - EuroIntervention
IS - 12
ER -