Interventions for valvular disease and heart failure

Surgical feasibility of ascending aorta manipulation after transcatheter aortic valve implantation: a computed tomography theoretical analysis

EuroIntervention 2021;16:e1533-e1540. DOI: 10.4244/EIJ-D-19-00991

Igor Belluschi
Igor Belluschi1, MD; Nicola Buzzatti1, MD; Vittorio Romano2, RT; Ole De Backer3, MD; Lars Søndergaard3, MD; Julia Karady4, MD; Pal Maurovich-Horvat4, MD; Kusha Rahgozar5, MD; Michele De Bonis1, MD; Alessandro Castiglioni1, MD; Antonio Colombo6, MD; Ottavio Alfieri1, MD; Matteo Montorfano2, MD; Azeem Latib5, MD
1. Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy; 2. Department of Interventional Cardiology, San Raffaele University Hospital, Milan, Italy; 3. The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagan, Denmark; 4. Heart and Vascular Center, Semmelweis University, Budapest, Hungary; 5. Department of Cardiology, Montefiore Medical Center, New York, NY, USA; 6. Department of Cardiology, Maria Cecilia Hospital, Cotignola, Italy

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.

Visual summary. Proper aortic cross-clamp and careful higher aortotomy after TAVI.

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aortic stenosisdegenerative valveimaging modalitiesmscttavi
Interventions for valvular diseaseTAVI
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