Anatomical feasibility of redo transcatheter aortic valve replacement based on post-TAVR CT imaging.

Abstract

Objectives: One of the risks of redo transcatheter aortic valve replacement is coronary artery obstruction caused by the cusps of the first transcatheter aortic valve. We evaluated the feasibility of this procedure based on data from post-transcatheter aortic valve replacement computed tomography scans. We also evaluated whether redo transcatheter aortic valve replacement could be a standard lifetime management option for patients with severe aortic stenosis.

Methods: The post-transcatheter aortic valve replacement computed tomography data of 143 patients who received balloon-expandable transcatheter aortic valves and 187 patients who received self-expanding transcatheter aortic valves were analyzed. The risk of coronary obstruction in redo transcatheter aortic valve replacement, defined by the transcatheter aortic valve commissure level above the coronary height and a transcatheter aortic valve-to-aorta distance of < 2.0 mm in each coronary sinus, was evaluated.

Results: The mean age of the patients was 85.5 ± 5.1 years (35% male), and the mean body surface area was 1.43 ± 0.17 m². The percentage of patients at a high risk of coronary obstruction was significantly higher in the self-expanding valve group (71.1%) than in the balloon-expandable valve group (32.2%). In both the balloon-expandable and self-expanding valve groups, the group at a high risk of coronary obstruction had smaller aortic roots.

Conclusions: Current transcatheter aortic valve devices may carry a higher risk of coronary obstruction in patients with small aortic roots. Careful patient selection and comprehensive pre-procedural assessment are necessary to reduce the risk for the patients' lifetime management.