Evaluation of coronary artery ostium obstruction caused by the commissure of transcatheter heart valve with the markers on transcatheter heart valve_West China Medical Journal

Authors：

WANG Yingdong ^1,2 , LIU Xian ^1,2 , WANG Geng ¹ , LIANG Zhenyang ¹ , JING Quanmin ¹ , HAN Yaling ¹ , LI Yang ¹ , QIU Miaohan ¹ , SUN Yu ³ , YU Jie ^1,4 , SHENG Yuhe ^1,4 ,  WANG Bin ¹ ,  XU Kai ¹

1. Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P. R. China;
2. The Graduate School, China Medical University, Shenyang, Liaoning 110016, P. R. China;
3. Department of Radiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P. R. China;
4. The Graduate School, Dalian Medical University, Dalian, Liaoning 116000, P. R. China;

Corresponding author：

WANG Bin, Email: wangbindl@hotmail.com; XU Kai, Email: xukai2001@sina.com

Keywords：

Transcatheter aortic valve replacement; severe aortic stenosis; computed tomographic angiography

DOI：

10.7507/1002-0179.202201134

Video：

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Objective To evaluate the coronary artery ostium obstruction caused by the commissure of transcatheter heart valve (THV) with the markers on THV under X-ray, which was identified by observing the position relationship between the commissure of THV and the coronary artery ostium from analyzing aortic root computed tomographic angiography (CTA) images after transcatheter aortic valve replacement (TAVR). Methods A retrospective analysis was performed on 25 patients undergoing TAVR who were checked with electrocardiographically gated CTA for the aortic root after the TAVR procedure between January 2020 and December 2021 in General Hospital of Northern Theater Command. The images of THV with the lowest position of non-coronary sinus and the right anterior oblique and caudal in most cases were observed when the THVs were deployed. The position relationships of the three markers on the THV after valve release were recorded, which were divided into three conditions, namely the three markers being averagely distributed, the middle marker being close to left, and the middle marker being close to right. Postoperative CTA images of the patients were analyzed. The angle between the commissure of THV and the coronary artery ostium was measured, and the angles in each group were presented as medium (lower quartile, upper quartile). Results A total of 17 patients were finally included. The angles between the commissure of THV and the left coronary artery ostium were 19.0 (16.0, 31.0)°, 36.0 (15.0, 44.0)°, and 3.0 (3.0, 5.0)° in the markers averagely distributed group (n=7), the middle marker close to left group (n=6), and the middle marker close to right group (n=4), respectively, which were significantly different (P=0.033). The angles between the commissure of THV and the right coronary artery ostium were 43.0 (25.0, 51.0)°, 47.0 (41.0, 57.0)°, and 13.0 (7.5, 21.0)° in the markers averagely distributed group, the middle marker close to left group, and the middle marker close to right group, respectively, which were significantly different (P=0.017). There was significant difference in the obstruction degrees of left coronary artery ostium by the commissure of THV (P=0.008), and no significant difference in the obstruction degrees of right coronary artery ostium (P=0.062). When the middle marker was close to right, there was no more than moderately obstruction on the right coronary artery ostium and no any obstruction on the left coronary artery ostium. When the middle marker was close to left, the obstruction rate of the left coronary artery ostium with more than moderate degree was 4/6 (66.7%) and it was 6/6 (100.0%) for the right coronary artery ostium. Conclusions The degree of coronary artery ostium obstruction by the commissure of THV can be accurately evaluated by using markers on THV. Among them, when the middle marker is close to right, the commissures of THV are least likely to block the coronary artery ostium.

Citation： WANG Yingdong, LIU Xian, WANG Geng, LIANG Zhenyang, JING Quanmin, HAN Yaling, LI Yang, QIU Miaohan, SUN Yu, YU Jie, SHENG Yuhe, WANG Bin, XU Kai. Evaluation of coronary artery ostium obstruction caused by the commissure of transcatheter heart valve with the markers on transcatheter heart valve. West China Medical Journal, 2022, 37(4): 531-536. doi: 10.7507/1002-0179.202201134 Copy

1.	Makkar RR, Fontana GP, Jilaihawi H, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med, 2012, 366(18): 1696-1704.
2.	Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
3.	Stachon P, Kaier K, Heidt T, et al. Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008-2015. Catheter Cardiovasc Interv, 2020, 95(4): 810-816.
4.	Goel SS, Ige M, Tuzcu EM, et al. Severe aortic stenosis and coronary artery disease-implications for management in the transcatheter aortic valve replacement era: a comprehensive review. J Am Coll Cardiol, 2013, 62(1): 1-10.
5.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic- valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
6.	Braghiroli J, Kapoor K, Thielhelm TP, et al. Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials. Cardiovasc Diagn Ther, 2020, 10(1): 59-71.
7.	Ochiai T, Chakravarty T, Yoon SH, et al. Coronary access after TAVR. JACC Cardiovasc Interv, 2020, 13(6): 693-705.
8.	Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg, 2007, 133(5): 1226-1233.
9.	Kocka V, Theriault-Lauzier P, Xiong TY, et al. Optimal fluoroscopic projections of coronary ostia and bifurcations defined by computed tomographic coronary angiography. JACC Cardiovasc Interv, 2020, 13(21): 2560-2570.
10.	Sheng Y, Yu J, Jing Q, et al. Determination of optimal fluoroscopic angulations for left main coronary artery ostial interventions: 3-dimensional computed tomography validation. J Interv Cardiol, 2022, 2022: 2411824.
11.	Fuchs A, Kofoed KF, Yoon SH, et al. Commissural alignment of bioprosthetic aortic valve and native aortic valve following surgical and transcatheter aortic valve replacement and its impact on valvular function and coronary filling. JACC Cardiovasc Interv, 2018, 11(17): 1733-1743.
12.	Kim WK, Pellegrini C, Ludwig S, et al. Feasibility of coronary access in patients with acute coronary syndrome and previous TAVR. JACC Cardiovasc Interv, 2021, 14(14): 1578-1590.
13.	Yudi MB, Sharma SK, Tang GHL, et al. Coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement. J Am Coll Cardiol, 2018, 71(12): 1360-1378.
14.	Tang GHL, Zaid S, Fuchs A, et al. Alignment of transcatheter aortic-valve neo-commissures (ALIGN TAVR): impact on final valve orientation and coronary artery overlap. JACC Cardiovasc Interv, 2020, 13(9): 1030-1042.
15.	Bieliauskas G, Wong I, Bajoras V, et al. Patient-specific implantation technique to obtain neo-commissural alignment with self-expanding transcatheter aortic valves. JACC Cardiovasc Interv, 2021, 14(19): 2097-2108.
16.	Tang GHL, Zaid S, Michev I, et al. “Cusp-Overlap” view simplifies fluoroscopy-guided implantation of self-expanding valve in transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2018, 11(16): 1663-1665.
17.	Ben-Shoshan J, Alosaimi H, Lauzier PT, et al. Double s-curve versus cusp-overlap technique: defining the optimal fluoroscopic projection for tavr with a self-expanding device. JACC Cardiovasc Interv, 2021, 14(2): 185-194.
18.	王斌, 徐凯, 荆全民, 等. 计算机断层扫描指导经皮主动脉瓣膜置换术导丝过瓣可行性研究. 临床军医杂志, 2020, 48(10): 1149-1152.
19.	Wang X, De Backer O, Bieliauskas G, et al. Cusp symmetry and coronary ostial eccentricity and its impact on coronary access following TAVR. JACC Cardiovasc Interv, 2022, 15(2): 123-134.
20.	Marwan M, Achenbach S. Role of cardiac CT before transcatheter aortic valve implantation (TAVI). Curr Cardiol Rep, 2016, 18(2): 21.

1. Makkar RR, Fontana GP, Jilaihawi H, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med, 2012, 366(18): 1696-1704.
2. Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
3. Stachon P, Kaier K, Heidt T, et al. Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008-2015. Catheter Cardiovasc Interv, 2020, 95(4): 810-816.
4. Goel SS, Ige M, Tuzcu EM, et al. Severe aortic stenosis and coronary artery disease-implications for management in the transcatheter aortic valve replacement era: a comprehensive review. J Am Coll Cardiol, 2013, 62(1): 1-10.
5. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic- valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
6. Braghiroli J, Kapoor K, Thielhelm TP, et al. Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials. Cardiovasc Diagn Ther, 2020, 10(1): 59-71.
7. Ochiai T, Chakravarty T, Yoon SH, et al. Coronary access after TAVR. JACC Cardiovasc Interv, 2020, 13(6): 693-705.
8. Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg, 2007, 133(5): 1226-1233.
9. Kocka V, Theriault-Lauzier P, Xiong TY, et al. Optimal fluoroscopic projections of coronary ostia and bifurcations defined by computed tomographic coronary angiography. JACC Cardiovasc Interv, 2020, 13(21): 2560-2570.
10. Sheng Y, Yu J, Jing Q, et al. Determination of optimal fluoroscopic angulations for left main coronary artery ostial interventions: 3-dimensional computed tomography validation. J Interv Cardiol, 2022, 2022: 2411824.
11. Fuchs A, Kofoed KF, Yoon SH, et al. Commissural alignment of bioprosthetic aortic valve and native aortic valve following surgical and transcatheter aortic valve replacement and its impact on valvular function and coronary filling. JACC Cardiovasc Interv, 2018, 11(17): 1733-1743.
12. Kim WK, Pellegrini C, Ludwig S, et al. Feasibility of coronary access in patients with acute coronary syndrome and previous TAVR. JACC Cardiovasc Interv, 2021, 14(14): 1578-1590.
13. Yudi MB, Sharma SK, Tang GHL, et al. Coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement. J Am Coll Cardiol, 2018, 71(12): 1360-1378.
14. Tang GHL, Zaid S, Fuchs A, et al. Alignment of transcatheter aortic-valve neo-commissures (ALIGN TAVR): impact on final valve orientation and coronary artery overlap. JACC Cardiovasc Interv, 2020, 13(9): 1030-1042.
15. Bieliauskas G, Wong I, Bajoras V, et al. Patient-specific implantation technique to obtain neo-commissural alignment with self-expanding transcatheter aortic valves. JACC Cardiovasc Interv, 2021, 14(19): 2097-2108.
16. Tang GHL, Zaid S, Michev I, et al. “Cusp-Overlap” view simplifies fluoroscopy-guided implantation of self-expanding valve in transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2018, 11(16): 1663-1665.
17. Ben-Shoshan J, Alosaimi H, Lauzier PT, et al. Double s-curve versus cusp-overlap technique: defining the optimal fluoroscopic projection for tavr with a self-expanding device. JACC Cardiovasc Interv, 2021, 14(2): 185-194.
18. 王斌, 徐凯, 荆全民, 等. 计算机断层扫描指导经皮主动脉瓣膜置换术导丝过瓣可行性研究. 临床军医杂志, 2020, 48(10): 1149-1152.
19. Wang X, De Backer O, Bieliauskas G, et al. Cusp symmetry and coronary ostial eccentricity and its impact on coronary access following TAVR. JACC Cardiovasc Interv, 2022, 15(2): 123-134.
20. Marwan M, Achenbach S. Role of cardiac CT before transcatheter aortic valve implantation (TAVI). Curr Cardiol Rep, 2016, 18(2): 21.

West China Medical Journal

Evaluation of coronary artery ostium obstruction caused by the commissure of transcatheter heart valve with the markers on transcatheter heart valve

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