Predicted vs Observed Valve to Coronary Distance in Valve-in-Valve TAVR: A Computed Tomography Study.

BACKGROUND

Preprocedural computed tomography (CT) workup with assessment of virtual transcatheter heart valve-to-coronary ostia (VTC) distance and transcatheter heart valve-to-sinus (VTS) distances is recommended to assess the risk of coronary obstruction following valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR).

OBJECTIVES

The authors sought to investigate the agreement of predicted VTC and VTS distances and observed post-TAVR anatomy on CT and their relationship with transcatheter heart valve (THV) expansion and deployment conditions.

METHODS

Fifty-one patients who underwent a balloon-expandable ViV procedure were included in this study. The expansion of the THV stent frame was evaluated at 4 levels: THV inflow, surgical heart valve (SHV) sewing ring, SHV outflow, and THV outflow. Assessment of the VTC/VTS distances was performed on the pre-TAVR CT, and THV-to-coronary ostia and THV-to-sinus distances were assessed on the post-TAVR CT.

RESULTS

Following the ViV procedure, the THV stent frame flared toward the outflow but was generally underexpanded at all levels, particularly at the SHV sewing ring level. Postdilatation impacted the extent of THV expansion, resulting in greater expansion than nominal balloon filling at all 4 THV levels (P < 0.001). Observed THV-to-coronary ostia distances were systematically larger than predicted by the VTC distance (mean difference 1.25 ±1.28 mm) in patients with nominal balloon filling but systematically smaller in case of postdilatation (mean difference -0.45 ± 0.52 mm). A similar relationship was observed between VTS and THV-to-sinus distance measurements.

CONCLUSIONS

With nominal balloon filling, VTC and VTS distances underestimate postprocedural distances due to THV frame underexpansion. However, postdilatation may lead to distances smaller than predicted due to THV overexpansion at the outflow level.

Informations de copyright

Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr Tzimas is supported by the Fondation Vaudoise de Cardiologie and the SICPA Foundation. Dr Meier is supported by the Swiss National Science Foundation (grant P2LAP3_199561) and the SICPA foundation. Dr Akodad has received research funding from Medtronic, Biotronik, MUSE Explore, and Federation Française de Cardiologie. Dr Sellers has served as a consultant for Medtronic, Edwards Lifesciences, Anteris, and Providence Health Care; and received research support from HeartFlow, Medtronic, ViVitro Labs, and Edwards Lifesciences. Dr Sathananthan has served as a consultant for Edwards Lifesciences, Medtronic, Anteris, and Boston Scientific; and received research funding from Edwards Lifesciences and Medtronic. Dr Leipsic has received unrestricted research grant from GE Healthcare; stock options and consulting fees from HeartFlow and Circle CVI; speaking fees from GE and Philips. Dr Webb has served as a consultant for Edwards Lifesciences; and received research funding from Edwards Lifesciences, Abbott, and ViVitro Labs. Dr Blanke has provided institutional CT core laboratory services to Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Laboratories, PiCardia, and Neovasc, without direct personal reimbursements; and served as a consultant to Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.