Author + information
Coronary compromise is a rare but serious complication of Transcatheter Aortic Valve Replacement (TAVR). There are no established predictors of this phenomenon.
We sought to evaluate the potential value of a novel parameter derived from contrast Computed Tomography (CT). Coronary leaflet length in relation to corresponding curved coronary distance (L/d, see figurebelow) was measured and compared it to traditional measures of coronary ostium height (h) ≤10 mm. These parameters were placed in the context of a minority of patients with coronary compromise. All patients studied had severe aortic stenosis and were treated with balloon–expandable TAVR.
Data was available in 138 patients with complete CT data. There were no cases of right coronary compromise. There were 2 cases of left main (LM) compromise in the initial series. Both of these had L/d>1 (1.03 and 1.4 respectively) but with h>10mm (16.7 mm and 15.1 mm respectively). However, L/d for the LM was common There were 3 cases of h≤10mm for the LM, none of whom had coronary compromise. Since this series, we have encountered 2 further cases of LM compromise, both with L/d>1 (1.06 and 1.24). Data will be updated for a consecutive series of over 300 patients, with an independent assessment of leaflet mobility and estimated leaflet mass by CT.
Leaflet length may be contributory in some cases of LM compromise after TAVR. A further understanding of other potential modifiers of this phenomenon is merited.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Interventional Aspects of CT and Other Novel Imaging Approaches
Abstract Category: 37. TCT@ACC–i2: Angiography and Interventional Aspects of CT/MR
Presentation Number: 2112–250
- 2013 American College of Cardiology Foundation