Interaction Between Balloon-Expandable Valves and Coronary Ostia: Angiographic Analysis and Impact on Coronary Access

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Background:

• Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
• Accurate placement of the balloon-expandable transcatheter heart valve (THV) is crucial to avoid coronary artery obstruction.
• Understanding THV positioning relative to coronary ostia is essential for procedural success and long-term outcomes.

Purpose of the Study:

• To evaluate the position of balloon-expandable valves (Sapien XT and Sapien 3) in relation to coronary ostia.
• To determine the impact of THV position on the feasibility and results of coronary angiography (CA) and percutaneous coronary intervention (PCI) post-TAVR.

Main Methods:

• Retrospective analysis of 533 patients who underwent TAVR with Sapien XT or Sapien 3 valves.
• Angiographic assessment of THV position relative to coronary ostia.
• Computed tomography (CT) analysis in 49 patients for opportunistic evaluation of THV position.
• Review of subsequent CA/PCI procedures in 53 patients.

Main Results:

• The THV stent frame exceeded coronary ostia in approximately 25% of patients, increasing to over 40% with the Sapien 3 valve.
• The Sapien 3 valve covered the left coronary artery ostium more frequently than Sapien XT (43% vs. 12%).
• THV position did not influence the feasibility, quality, or outcomes of subsequent CA/PCI.

Conclusions:

• Balloon-expandable THV implantation, particularly with Sapien 3, can result in the valve frame overlying coronary ostia.
• Despite potential ostial coverage, THV position does not compromise the ability to perform or the success of coronary angiography and interventions post-TAVR.