Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up

Francesca Romana Prandi, Yoav Niv Granot, Davide Margonato, Martina Belli, Federica Illuminato, Manish Vinayak, Francesco Barillà, Francesco Romeo, Gilbert H.L. Tang, Samin Sharma, Annapoorna Kini, Stamatios Lerakis

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations

Abstract

Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is emerging as an effective treatment for patients with symptomatically failing bioprosthetic valves and a high prohibitive surgical risk; a longer life expectancy has led to a higher demand for these valve reinterventions due to the increased possibilities of outliving the bioprosthetic valve’s durability. Coronary obstruction is the most feared complication of valve-in-valve (ViV) TAVR; it is a rare but life-threatening complication and occurs most frequently at the left coronary artery ostium. Accurate pre-procedural planning, mainly based on cardiac computed tomography, is crucial to determining the feasibility of a ViV TAVR and to assessing the anticipated risk of a coronary obstruction and the eventual need for coronary protection measures. Intraprocedurally, the aortic root and a selective coronary angiography are useful for evaluating the anatomic relationship between the aortic valve and coronary ostia; transesophageal echocardiographic real-time monitoring of the coronary flow with a color Doppler and pulsed-wave Doppler is a valuable tool that allows for a determination of real-time coronary patency and the detection of asymptomatic coronary obstructions. Because of the risk of developing a delayed coronary obstruction, the close postprocedural monitoring of patients at a high risk of developing coronary obstructions is advisable. CT simulations of ViV TAVR, 3D printing models, and fusion imaging represent the future directions that may help provide a personalized lifetime strategy and tailored approach for each patient, potentially minimizing complications and improving outcomes.

Original languageEnglish
Article number187
JournalJournal of Cardiovascular Development and Disease
Volume10
Issue number5
DOIs
StatePublished - May 2023

Keywords

  • CT
  • TAVR-in-SAVR
  • TAVR-in-TAVR
  • TEE
  • coronary flow
  • coronary obstruction
  • valve-in-valve TAVR

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