Abstract
Objective: The optimal risk assessment of coronary obstruction (CO) during balloon-expandable transcatheter aortic valve replacement (TAVR) has not been established in patients with severe aortic stenosis of native aortic valve. We aimed to retrospectively determine the anatomical features of native aortic valve associated with CO during balloon-expandable TAVR.
Methods: Between June 2010 and December 2019, 279 consecutive patients with symptomatic severe aortic stenosis of native aortic valve were treated with a SAPIEN XT or SAPIEN 3 valve. Coronary angiography was performed in patients with suspected CO on aortograms or transesophageal echocardiograms. Subsequently, intravascular ultrasound was performed to confirm the presence of CO. In patients whom preprocedural contrast-enhanced computed tomography (CT) measurements were obtained, we compared the anatomical parameters between those with and without CO.
Results: Four patients (1.4%) had significant stenosis at the left coronary artery (LCA) ostium and underwent stent deployment, and 7 patients (2.5%) had mild stenosis at the LCA ostium and underwent conservative treatment. Preprocedural contrast-enhanced CT measurements were obtained in 234 patients (83.9%), showing that the incidence of CO was not significantly different between patients with both left coronary height <12 mm and left sinuses of Valsalva diameter <30 mm and the remaining patients (4.4% [2/45 patients] vs. 4.8% [9/189 patients], P >0.99), but was significantly higher in patients with both the left leaflet length to coronary distance ratio (LCR) >1 and the left projected virtual transcatheter valve to coronary ostium distance (p-VTC) <4 mm than in the remaining patients (31.8% [7/22 patients] vs. 1.9% [4/212 patients], P <0.001).
Conclusion: The left LCR >1 and the left p-VTC <4 mm may be associated with CO during balloon-expandable TAVR.
