The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

CT-scan theoretical analysis for aortic cross-clamp and opening after transcatheter aortic valve implantation

DOI: 10.4244/EIJ-D-19-00991

1. San Raffaele University Hospital, Milan, Italy - Cardiac Surgery Department, Italy
2. San Raffaele University Hospital, Milan, Italy – Cardiac Surgery Department
3. San Raffaele University Hospital, Milan, Italy – Interventional Cardiology Department
4. Rigshospitalet, University of Copenhagen, Denmark – The Heart Center
5. Semmelweis University, Budapest, Hungary – Heart and Vascular Center
6. Montefiore Medical Center, New York, US – Cardiology Department
7. Maria Cecilia Hospital, Cotignola, Italy – Cardiology Department
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Aims:TAVI expansion will imply 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 analyzed 117 CTs acquired after TAVI procedures with high stent prostheses in three high-volume centers 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 sino-tubular junction and the first free site for aortotomy being 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 to not be an issue when cardiac surgery is needed after a TAVI, but 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.

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