The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)
A computed tomography study of coronary access and coronary obstruction after redo transcatheter aortic valve implantation
Nicola Buzzatti1, M.D.; Matteo Montorfano1; Vittorio Romano1; Ole De Backer2; Lars Soendergaard2; Liesbeth Rosseel3; Pal Maurovich-Horvat4; Julia Karady4; Béla Merkely4; Bernard Prendergast5; Michele De Bonis1; Antonio Colombo6; Azeem Latib7;
1. San Raffaele Scientific Institute, Milan, Italy 3. Rigshospitalet - University Hospital, Copenhagen, Denmark 4. Galway University Hospital, Galway, Ireland 5. Heart and Vascular Center, Semmelweis University, Budapest, Hungary 6. St. Thomas’ Hospital, London, United Kingdom 7. Maria Cecilia Hospital, Cotignola, Italy 8. Montefiore Medical Center, New York, NY, United States, United States
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Aims: to investigate the risk of impaired coronary access and coronary obstruction after REDO-TAVI.
Methods and Results: Post-procedure multi-detector computed tomography (MDCT) scans of 221 TAVI recipients were analyzed. Increased risk of impaired coronary access was defined as coronary ostium below TAVI commissures with valve-to-aorta distance <2mm at this level. Increased risk was found in 123 (55.6%) cases, the left main involved in 109 (49.3%), the right coronary in 79 (35.7%), both in 65 (29.4%) patients. Small sino-tubular 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 coronary ostium below TAVI commissures with valve-to-coronary distance <2mm was observed in 14.9% of patients, and in 17.2% of cases complete sealing of STJ would occur.
Conclusions: Post-TAVI MDCT suggested an increased potential risk of impaired coronary access in more than half of patients should REDO-TAVI be required, predicted by 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.