Circulation journal : official journal of the Japanese Circulation Society · 2025
Estimation of Coronary Obstruction Risk for the Transcatheter Aortic Valve Implantation in Surgical Aortic Valve (TAV-in-SAV) Procedure.
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Kawamura Ai, Shimamura Kazuo, Yoshioka Daisuke, Misumi Yusuke, Yamashita Kizuku, Yajima Shin, Maeda Koichi, Kawamura Takuji, Saito Shunsuke, Matsuhiro Yutaka, Kosugi Shumpei, Nakamura Daisuke, Mizote Isamu, Sakata Yasushi, Miyagawa Shigeru
Аннотация
BACKGROUND: To consider transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV) as a secondary intervention, the risk of coronary obstruction during future TAV-in-SAV should be assessed prior to initial SAV replacement (SAVR), especially in Japanese patients with a small body size and aortic root anatomy. In this study we simulated the risk of coronary obstruction and identified associated anatomical factors.
METHODS AND RESULTS: We retrospectively analyzed pre- and post-SAVR computed tomography scans of 115 patients and simulated the risk of coronary obstruction. High risk was defined as postoperative coronary arteries located below the risk plane (RP) and a valve-to-coronary distance <4 mm or a valve-to-aorta distance <2 mm; 28.7% of patients were classified as high risk. Preoperative right and left coronary artery heights of ≥22 and ≥18 mm, respectively, were important parameters for classifying patients with postoperative coronary arteries located above or below the RP. An expected valve-to-sinotubular junction (STJ) distance (defined as the difference between the preoperative STJ diameter and the expected internal valve diameter) ≥7 mm was another important parameter to stratify patients into low- and high-risk categories.
CONCLUSIONS: TAV-in-SAV was anatomically unfeasible in 28.7% of patients, and the coronary obstruction risk was associated with aortic root anatomy and implanted valve size. These results may provide a basis for considering TAV-in-SAV as a secondary option in Japanese patients with a small body size and aortic root anatomy.
METHODS AND RESULTS: We retrospectively analyzed pre- and post-SAVR computed tomography scans of 115 patients and simulated the risk of coronary obstruction. High risk was defined as postoperative coronary arteries located below the risk plane (RP) and a valve-to-coronary distance <4 mm or a valve-to-aorta distance <2 mm; 28.7% of patients were classified as high risk. Preoperative right and left coronary artery heights of ≥22 and ≥18 mm, respectively, were important parameters for classifying patients with postoperative coronary arteries located above or below the RP. An expected valve-to-sinotubular junction (STJ) distance (defined as the difference between the preoperative STJ diameter and the expected internal valve diameter) ≥7 mm was another important parameter to stratify patients into low- and high-risk categories.
CONCLUSIONS: TAV-in-SAV was anatomically unfeasible in 28.7% of patients, and the coronary obstruction risk was associated with aortic root anatomy and implanted valve size. These results may provide a basis for considering TAV-in-SAV as a secondary option in Japanese patients with a small body size and aortic root anatomy.