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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
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Commissural Misalignment Following Valve-in-Valve Transcatheter Aortic Valve Implantation.
Matthias Raschpichler1, Johannes Rotta Detto Loria2, Vivek Patel3
1University Hospital of Cardiac Surgery, Heart Center Leipzig at Leipzig University, Leipzig, Germany.
Summary
Commissural misalignment (CMA) during valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for failed surgical aortic valve replacement (SAVR) reduces technical success due to coronary obstruction. However, mid-term survival remains unaffected by CMA.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Data on commissural misalignment (CMA) in valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for failed surgical aortic valve replacement (SAVR) is limited.
- Understanding CMA's impact is crucial for optimizing ViV-TAVI procedures.
Purpose of the Study:
- To investigate the effect of CMA on clinical and hemodynamic outcomes after ViV-TAVI in patients with prior SAVR.
- To identify specific complications associated with CMA during ViV-TAVI.
Main Methods:
- Retrospective analysis of 180 patients undergoing ViV-TAVI for failed SAVR at two institutions.
- Assessment of CMA using post-procedural computed tomography (CT).
- Evaluation of Valve Academic Research Consortium (VARC)-3 clinical endpoints, hypoattenuated leaflet thickening (HALT), hemodynamics, and mortality.
Main Results:
- Commissural misalignment (CMA) was present in 19.4% of patients.
- CMA was associated with significantly reduced technical success (80% vs. 93%, p=0.03), primarily due to increased coronary obstruction (17.1% vs. 5.6%, p=0.03).
- Hypoattenuated leaflet thickening (HALT) and device success rates were similar between groups; mid-term survival was comparable (84.6%).
Conclusions:
- Commissural misalignment (CMA) during ViV-TAVI for failed SAVR is linked to lower technical success rates.
- Increased risk of coronary obstruction is the main driver of reduced success in CMA cases.
- Despite procedural challenges, CMA does not appear to impact mid-term survival.
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