Related Experiment Video
Updated: Aug 17, 2026
Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Coronary Access After TAVR With a Cylindrical-Shaped Valve: Learning From LOTUS
Noriaki Moriyama1, Koki Shishido1, Shohei Yokota1
1Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan.
Insights
Coronary access after transcatheter aortic valve replacement (TAVR) can be challenging. Multi-detector computed tomography (MDCT) can identify unfavorable coronary access (CA) risks after TAVR, predicting lower cannulation success rates.
Area of Science:
- Cardiovascular Imaging and Intervention
- Interventional Cardiology
- Structural Heart Disease
Background:
- Coronary access (CA) feasibility post-transcatheter heart valve (THV) implantation is not well-established.
- Cylindrical THV designs may pose challenges for future coronary access.
Purpose of the Study:
- Assess CA feasibility after LOTUS transcatheter aortic valve replacement (TAVR) using multi-detector computed tomography (MDCT).
- Evaluate the reliability of an algorithm for detecting unfavorable CA post-TAVR.
Main Methods:
- MDCT scans of 41 patients post-TAVR were analyzed.
- Assessed the relationship and distance between the THV and coronary ostia.
- Defined unfavorable CA based on specific valve-to-junction and valve-to-ostia distances.
Main Results:
- MDCT identified unfavorable CA in 29.3% of left and 41.5% of right coronary arteries.
- Over half of patients (53.7%) had at least one unfavorable CA.
- Unfavorable CA correlated with significantly lower selective coronary cannulation success rates (20% left, 0% right).
Conclusions:
- Future coronary access post-TAVR with cylindrical THVs may be challenging.
- Post-TAVR MDCT algorithm aids in predicting the risk of unsuccessful selective coronary cannulation.
Background/Purpose:
Data on the feasibility of coronary access (CA) through above or outside of the cylindrical shaped-transcatheter heart valve (THV) are very limited. The aims of the present study were to assess the feasibility of CA after transcatheter aortic valve replacement (TAVR) with the LOTUS using multi detector computed tomography (MDCT) and the reliability of algorithm detecting unfavorable CA.
Methods/Materials:
Post-TAVR MDCT of 41 patients with 82 coronary arteries were evaluated. The relationship and distance between the THV flame and sinotubular junction (STJ) and coronary ostia were assessed. Unfavorable CA was defined as the valve-to-STJ distance < 2-mm or the valve-to-coronary ostia distance < 2-mm if the THV flame was above STJ or coronary ostia.
Results:
MDCT-identified unfavorable CA was observed in 29.3% for the left coronary artery and 41.5% for the right coronary artery. In total, 53.7% of patients had at least one unfavorable CA and 14.6% of those had unfavorable CA for both left and right coronary artery. While patients underwent coronary angiography after TAVR, the success rates of selective coronary cannulation were significantly lower in patients with MDCT-identified unfavorable CA in comparison to those with favorable CA for left (20.0% vs. 100%, P = 0.002) and right coronary artery (0% vs. 100%, P < 0.001).
Conclusions:
Future CA through above or outside of a cylindrical shaped THV may be challenging with a significant probability. Our algorithm identifying unfavorable CA using post-MDCT seems to be useful for estimating the risk of unsuccessful selective cannulation.
Related Concept Videos
01:16Heart Valves
The AV valves prevent the backflow of blood from the ventricles to the atria during ventricular contraction. These valves function with the assistance of the chordae tendineae and papillary muscles. When the ventricles are relaxed, the chordae tendineae are slack, allowing blood to flow from the atria into the...
01:24Cardiac Catheterization III: Left Heart Catheterization