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

Nicola Buzzatti, Matteo Montorfano, Vittorio Romano, Ole De Backer, Lars Soendergaard, Liesbeth Rosseel, Pal Maurovich-Horvat, Julia Karady, Bela Merkely, Bernard Prendergast, Michele De Bonis, Antonio Colombo, Azeem Latib

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)E1005-E1013
JournalEuroIntervention
Volume16
Issue number12
DOIs
StatePublished - 2020
Externally publishedYes

Keywords

  • Coronary artery disease
  • Coronary occlusion
  • TAVI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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