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Updated: May 6, 2026

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

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Management of difficult coronary anatomy during transcatheter aortic valve implantation: what are the key issues?

Takayuki Onishi1, Gilbert H L Tang1,2

  • 1Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai.

Current Opinion in Cardiology
|April 30, 2025
PubMed

Insights

Predicting and preventing coronary obstruction during transcatheter aortic valve replacement (TAVR) is vital. Strategies include preprocedural planning and leaflet modification to maintain coronary perfusion in high-risk patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Coronary obstruction during transcatheter aortic valve replacement (TAVR) poses a significant mortality risk.
  • Accurate prediction and prevention are essential for successful TAVR outcomes.

Purpose of the Study:

  • To review current methods for predicting and preventing coronary obstruction in TAVR.
  • To discuss strategies for managing coronary access and perfusion in both native and redo TAVR procedures.

Main Methods:

  • Assessment of anatomical factors like aortic cusp height, coronary artery height, and valve-to-coronary distance for native TAVR.
  • Evaluation of the VIVID classification for risk stratification in redo TAVR of failed bioprosthetic surgical valves.
  • Analysis of implantation depth, valve sizing (in-vivo CT vs. bench), and leaflet modification techniques.

Main Results:

  • Specific anatomical features predict coronary obstruction risk in native TAVR.
  • The VIVID classification aids in risk assessment for redo TAVR.
  • Implantation depth and valve sizing impact redo TAVR feasibility and coronary access.
  • Leaflet modification and stenting techniques can preserve coronary perfusion.

Conclusions:

  • Coronary preservation in high-risk TAVR patients remains a complex challenge.
  • Further research into preprocedural planning and advanced leaflet modification techniques is necessary.
Abstract

Keywords:
coronary occlusioncoronary protection: redo transcatheter aortic valve replacementleaflet modificationtranscatheter aortic valve replacement

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