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Redo TAVR With Asymmetric Coronary Risk: Interpreting Borderline CT Findings
Connor J McKechnie1, Nicolas J Valle1, Omar A Saleh1
1Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Eastern Virginia Medical School, Norfolk, Virginia, USA.
JACC. Case Reports
|August 5, 2026
Summary
Computed tomography (CT) and computational modeling aid in planning redo transcatheter aortic valve replacement (TAVR). These methods help assess coronary obstruction risk, ensuring safe valve implantation without complications.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Computational Fluid Dynamics
Background:
- Degeneration of prior transcatheter valves necessitates redo transcatheter aortic valve replacement (TAVR).
- Accurate pre-procedural planning is crucial to mitigate risks, particularly coronary obstruction.
Purpose of the Study:
- To evaluate the utility of computed tomography (CT) and computational modeling in planning redo TAVR.
- To assess the risk of coronary obstruction in a patient with borderline CT findings.
Main Methods:
- A 77-year-old female with degenerated prior TAVR underwent CT and computational modeling for redo TAVR planning.
- CT assessed leaflet calcification and valve-to-coronary distance.
- Computational modeling evaluated leaflet-coronary clearance.
Main Results:
- CT showed borderline left-sided valve-to-coronary distance (3.27 mm), suggesting potential left main coronary artery obstruction risk.
- Computational modeling indicated adequate leaflet-coronary clearance, reassuring for coronary obstruction risk.
- Redo TAVR with a 26-mm Evolut FX was successfully performed without leaflet modification or coronary obstruction.
Conclusions:
- Borderline CT findings in redo TAVR planning require careful, coronary-specific interpretation.
- Computational modeling can provide valuable reassurance for avoiding leaflet modification when coronary obstruction risk is a concern.
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