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Published on: June 3, 2018
Anatomical feasibility of redo transcatheter aortic valve replacement based on post-TAVR CT imaging
Tohru Takaseya1, Ken-Ichiro Sasaki2, Naoki Itaya2
1Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan. ttakaseya@kurume-u.ac.jp.
Insights
Redo transcatheter aortic valve replacement poses a risk of coronary obstruction, particularly with self-expanding valves in patients with small aortic roots. Careful pre-procedural assessment is crucial for safe lifetime management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Redo transcatheter aortic valve replacement (TAVR) is an emerging procedure for managing severe aortic stenosis.
- Coronary artery obstruction is a significant risk following TAVR, potentially caused by the prior valve's components.
Purpose of the Study:
- To evaluate the feasibility of redo TAVR by assessing coronary obstruction risk using post-TAVR computed tomography (CT) scans.
- To determine if redo TAVR can be a viable lifetime management strategy for severe aortic stenosis.
Main Methods:
- Analysis of post-TAVR CT scans from 143 patients with balloon-expandable valves and 187 with self-expanding valves.
- Evaluation of coronary obstruction risk based on valve commissure height and TAVR-to-aorta distance.
Main Results:
- A higher percentage of patients receiving self-expanding valves (71.1%) were at high risk for coronary obstruction compared to those with balloon-expandable valves (32.2%).
- Patients at high risk for coronary obstruction in both groups exhibited smaller aortic root dimensions.
Conclusions:
- Current TAVR devices may increase coronary obstruction risk in patients with smaller aortic roots.
- Careful patient selection and thorough pre-procedural evaluation are essential for mitigating risks in redo TAVR for lifetime management.
Objectives:
One of the risks of redo transcatheter aortic valve replacement is coronary artery obstruction caused by the cusps of the first transcatheter aortic valve. We evaluated the feasibility of this procedure based on data from post-transcatheter aortic valve replacement computed tomography scans. We also evaluated whether redo transcatheter aortic valve replacement could be a standard lifetime management option for patients with severe aortic stenosis.
Methods:
The post-transcatheter aortic valve replacement computed tomography data of 143 patients who received balloon-expandable transcatheter aortic valves and 187 patients who received self-expanding transcatheter aortic valves were analyzed. The risk of coronary obstruction in redo transcatheter aortic valve replacement, defined by the transcatheter aortic valve commissure level above the coronary height and a transcatheter aortic valve-to-aorta distance of < 2.0 mm in each coronary sinus, was evaluated.
Results:
The mean age of the patients was 85.5 ± 5.1 years (35% male), and the mean body surface area was 1.43 ± 0.17 m2. The percentage of patients at a high risk of coronary obstruction was significantly higher in the self-expanding valve group (71.1%) than in the balloon-expandable valve group (32.2%). In both the balloon-expandable and self-expanding valve groups, the group at a high risk of coronary obstruction had smaller aortic roots.
Conclusions:
Current transcatheter aortic valve devices may carry a higher risk of coronary obstruction in patients with small aortic roots. Careful patient selection and comprehensive pre-procedural assessment are necessary to reduce the risk for the patients' lifetime management.
