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Distance between valvular leaflet and coronary ostium predicting risk of coronary obstruction during TAVR

Jun-Hyok Oh1, Yuhei Kobayashi2, Guson Kang3

  • 1Department of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, South Korea.

International Journal of Cardiology. Heart & Vasculature
|December 17, 2021
PubMed

Insights

A new measurement, Expected Leaflet-to-ostium Distance (ELOD), can help predict coronary artery obstruction after transcatheter aortic valve replacement (TAVR). An ELOD less than 2mm combined with longer leaflet length indicates a higher risk.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
  • Coronary artery obstruction is a rare but serious complication following TAVR.
  • Predicting and preventing this complication is crucial for patient safety.

Purpose of the Study:

  • To evaluate the predictive value of the distance between the aortic valve and coronary ostia for coronary artery obstruction post-TAVR.
  • To introduce and validate a novel metric, Expected Leaflet-to-ostium Distance (ELOD), for risk assessment.

Main Methods:

  • Retrospective analysis of pre-TAVR computed tomography (CT) scans from 177 patients.
  • Calculation of ELOD by subtracting leaflet thickness and specific distances from CT measurements.
  • Comparison of variables between patients with and without coronary obstruction, using logistic regression analysis.

Main Results:

  • Analysis included 177 patients and 353 coronary arteries.
  • No significant differences in mean annulus or sinus of Valsalva diameters between groups.
  • Three cases of coronary obstruction were identified. ELOD ≤ 2 mm combined with longer leaflet length was associated with obstruction (log OR = 6.180, p < 0.001).

Conclusions:

  • A combination of ELOD < 2 mm and leaflet length exceeding mid-ostial height may indicate an increased risk of coronary obstruction during TAVR.
  • This finding could aid in pre-procedural risk stratification and planning for TAVR.
Abstract

Keywords:
CT, computed tomographyCoronary arteryDistanceELOD, Expected Leaflet-to-ostium DistanceHeightObstructionPCI, percutaneous coronary interventionSAVR, surgical aortic valve replacementSHV, surgical heart valveSOV, sinus of ValsalvaSTS PROM, society of thoracic surgeons predicted risk of mortalityTAVRTAVR, transcatheter aortic valve replacementTEE, transesophgeal echocardiographyTHV, transcatheter heart valveViV, valve-in-valve

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