Coronary Access After TAVR With a Cylindrical-Shaped Valve: Learning From LOTUS

Noriaki Moriyama; Koki Shishido; Shohei Yokota; Futoshi Yamanaka; Eiji Koyama; Yusuke Tamaki; Yoichi Sugiyama; Takahiro Hayashi; Takashi Yamada; Yuka Mashimo; Hiroaki Yokoyama; Masashi Yamaguchi; Tamiharu Yamagishi; Kazuki Tobita; Shingo Mizuno; Yutaka Tanaka; Masato Murakami; Saeko Takahashi; Shigeru Saito

doi:10.1016/j.carrev.2021.06.001

Coronary Access After TAVR With a Cylindrical-Shaped Valve: Learning From LOTUS

Cardiovasc Revasc Med. 2022 Apr:37:23-33. doi: 10.1016/j.carrev.2021.06.001. Epub 2021 Jun 4.

Authors

Noriaki Moriyama¹, Koki Shishido², Shohei Yokota², Futoshi Yamanaka², Eiji Koyama², Yusuke Tamaki², Yoichi Sugiyama², Takahiro Hayashi², Takashi Yamada², Yuka Mashimo², Hiroaki Yokoyama², Masashi Yamaguchi², Tamiharu Yamagishi², Kazuki Tobita², Shingo Mizuno², Yutaka Tanaka², Masato Murakami², Saeko Takahashi², Shigeru Saito²

Affiliations

¹ Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan. Electronic address: e2718nm@gmail.com.
² Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan.

PMID: 34119436
DOI: 10.1016/j.carrev.2021.06.001

Abstract

Background/purpose: Data on the feasibility of coronary access (CA) through above or outside of the cylindrical shaped-transcatheter heart valve (THV) are very limited. The aims of the present study were to assess the feasibility of CA after transcatheter aortic valve replacement (TAVR) with the LOTUS using multi detector computed tomography (MDCT) and the reliability of algorithm detecting unfavorable CA.

Methods/materials: Post-TAVR MDCT of 41 patients with 82 coronary arteries were evaluated. The relationship and distance between the THV flame and sinotubular junction (STJ) and coronary ostia were assessed. Unfavorable CA was defined as the valve-to-STJ distance < 2-mm or the valve-to-coronary ostia distance < 2-mm if the THV flame was above STJ or coronary ostia.

Results: MDCT-identified unfavorable CA was observed in 29.3% for the left coronary artery and 41.5% for the right coronary artery. In total, 53.7% of patients had at least one unfavorable CA and 14.6% of those had unfavorable CA for both left and right coronary artery. While patients underwent coronary angiography after TAVR, the success rates of selective coronary cannulation were significantly lower in patients with MDCT-identified unfavorable CA in comparison to those with favorable CA for left (20.0% vs. 100%, P = 0.002) and right coronary artery (0% vs. 100%, P < 0.001).

Conclusions: Future CA through above or outside of a cylindrical shaped THV may be challenging with a significant probability. Our algorithm identifying unfavorable CA using post-MDCT seems to be useful for estimating the risk of unsuccessful selective cannulation.

Keywords: Coronary access; Selective coronary cannulation; Transcatheter aortic valve replacement.

MeSH terms

Aortic Valve / diagnostic imaging
Aortic Valve / surgery
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / surgery
Heart Valve Prosthesis*
Humans
Prosthesis Design
Reproducibility of Results
Transcatheter Aortic Valve Replacement* / adverse effects
Treatment Outcome