RedoTAVR coronary obstruction risk in small annuli: A post-TAVR CT study

Redo-transcatheter aortic valve replacement (redoTAVR) is increasingly relevant as younger patients undergo TAVR. Patients with small annuli may present anatomical constraints.

This study evaluated predicted coronary obstruction (CO) risk in case of redoTAVR in small versus non-small annuli using post-TAVR computed tomography (CT) in patients treated by supra-annular self-expanding valves (SEVs) or balloon-expandable valves (BEVs). 167 post-TAVR CT scans were analyzed. Patients were stratified into small annuli (≤430 ​mm²) and non-small annuli groups (>430 ​mm²). Risk plane for redoTAVR was assessed at node 4, 5 and 6 for SEVs and at the transcatheter heart valve (THV) outflow for BEVs. The minimal valve-to-coronary (VTC) and valve-to-aorta (VTA) distances were measured from the THV to the left main stem (LM)/right coronary artery (RCA) ostia and from the THV to the aorta above the LM/RCA respectively. High CO risk was defined as VTC <4 ​mm or VTA <2 ​mm when the coronary ostium lay below the risk plane.

In small annuli, SEVs were associated with increased predicted CO risk after redoTAVR compared to BEVs, considering risk plane at node 6 (OR ​= ​15.52, p ​< ​0.001) or node 5 (OR ​= ​3.13, p ​= ​0.03), while not at node 4. In non-small annuli, SEVs did not increase predicted CO risk versus BEVs.

Predicted CO risk at redoTAVR in small annuli depends on index valve type and redo implantation height. Our findings support accurate index-procedure planning and meticulous planning and execution of redoTAVR, particularly in small annuli.