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Position of Edwards SAPIEN transcatheter valve in the aortic root in relation with the coronary ostia: implications
Spyridon Katsanos1, Philippe Debonnaire, Frank van der Kley
1Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Insights
Stable coverage of coronary ostia by the Edwards SAPIEN valve frame after transcatheter aortic valve implantation (TAVI) is infrequent. This valve placement rarely limits the need for or success of subsequent percutaneous coronary intervention (PCI).
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- The Edwards SAPIEN valve frame is sometimes deployed higher than recommended during transcatheter aortic valve implantation (TAVI).
- This higher deployment can lead to overlap of the coronary ostia, potentially impacting coronary blood flow.
Purpose of the Study:
- To investigate the implications of coronary ostia coverage by the Edwards SAPIEN valve frame following TAVI.
- To assess the impact on myocardial ischemia and the need for subsequent percutaneous coronary intervention (PCI).
Main Methods:
- Evaluated 142 patients who received the Edwards SAPIEN valve, using multi-detector row computed tomography for 1-month follow-up.
- Assessed the position of the valve frame relative to the coronary ostia.
- Measured troponin T levels post-TAVI and recorded subsequent PCI events.
Main Results:
- Full coverage of the left coronary ostium occurred in 2.1% and the right in 7.7% of patients.
- No significant difference in troponin T levels was observed between patients with covered versus uncovered ostia.
- Subsequent PCI rates were similar in patients with any ostial coverage compared to those with no coverage.
Conclusions:
- Complete overlap of coronary ostia by the Edwards SAPIEN valve frame is uncommon after TAVI.
- In most cases, this overlap does not impede the ability to perform subsequent percutaneous coronary intervention.
Objectives:
To determine the implications of stable coverage of the coronary ostia by the Edwards SAPIEN valve frame in terms of myocardial ischemia and subsequent percutaneous coronary intervention (PCI), following transcatheter aortic valve implantation (TAVI).
Background:
Edwards SAPIEN frame is frequently deployed relatively higher than recommended and may overlap the coronary ostia.
Methods:
A total of 142 patients (age 81 ± 7 years, male 49%) treated with Edwards SAPIEN valve and with multi-detector row computed tomography at 1 month follow-up were evaluated. The position of the frame in relation to the coronary ostia was assessed. Levels of troponin T were measured 12-24 hr after TAVI. PCI events at follow-up were recorded.
Results:
The left coronary ostium was fully covered in three (2.1%) patients and the right coronary ostium in 11 (7.7%). There were no differences in troponin T levels between patients with fully covered ostia versus patients with partly or non-covered ostia (0.24 (0.13-0.50) μg/L versus 0.35 (0.15-0.55) μg/L, respectively; P = 0.377). At 30 ± 15 months follow up, 10 (7%) patients underwent successful PCI. Rate of subsequent PCI was similar between patients with any covered ostium and patients with non-covered ostia [4 (7.8%) vs. 6 (6.5%), P = 0.780, respectively].
Conclusions:
Full overlap of the coronary ostia by Edwards SAPIEN frame is infrequent and in most cases does not limit subsequent PCI.
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