Comparative analysis of anatomic changes and feasibility of valve-in-valve transcatheter aortic valve replacement between Konno and Y-incision aortic root enlargement

Abstract

Objective

To evaluate anatomic changes in the aortic root after different aortic root enlargement (ARE) techniques and assess the risk of coronary obstruction during future valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) procedures.

Methods

In this retrospective analysis of 15 patients who underwent bioprosthetic aortic valve replacement with ARE using either the Konno or Y-incision technique, preoperative and postoperative computed tomography CT scans were reviewed to measure annular diameter, left ventricular outflow tract (LVOT), sinus of Valsalva (SOV), sinotubular junction, and coronary ostia locations. The risk of coronary obstruction was evaluated using virtual transcatheter heart valve-to-coronary ostium distance (VTC) and transcatheter heart valve-to-aorta distance (VTA).

Results

Both groups showed significant increases in annulus and SOV sizes; however, only the Konno group exhibited a significant increase in LVOT size. The distance from the valve center to the coronary ostia was significantly greater in the Konno group compared to the Y-incision group (+4.2 ± 3.5 mm for the left/right coronary artery in the Konno group vs +2.4 ± 0.6 mm in the Y-incision group). The Konno group demonstrated greater VTC and VTA, with all cases achieving VTC ≥4 mm and VTA ≥2 mm. In the Y-incision group, 33.0% had VTC <4 mm and 17.0% had VTA <2 mm.

Conclusions

The Konno procedure significantly increased LVOT size and access space to the coronary ostia, reducing the risk of coronary obstruction during future ViV-TAVR. These findings suggest that the Konno procedure may provide more favorable conditions compared to the Y-incision in such cases.