Reobtain Coronary Ostia Cannulation Beyond Transcatheter Aortic Valve Stent (RE-ACCESS)

2019 ◽  
Author(s):  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve ◽  
Coronary Ostia

scholarly journals P218 Accuracy and reproducibility of aortic root assessment by eSie Valves in patients candidate to transcatheter aortic valve implantation: a comparative study with computed tomography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Granata ◽  
A Veltri ◽  
S Iuliano ◽  
V Romano ◽  
S Stella ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Aortic Root ◽  
3D Model ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Coronary Ostia ◽  
Valve Implantation

Abstract Background Accurate imaging assessment of the aortic root (AR) is critical for prosthesis sizing in transcatheter aortic valve implantation. Multislice computed tomography (MSCT) is the gold standard for this purpose. 3D transesophageal (3D-TOE) reconstruction tools have recently been introduced, which automatically configures a geometric model of AR from 3D-TOE dataset and perform quantitative analyses of the AR. Purpose The aim of the study was to compare semi-automated measurements of AR obtained by eSie Valves (EV) (Siemens Medical Solution, California, USA) tool with MSCT. Methods We prospectively enrolled 26 consecutive patients (mean age 79.5 ± 7.5 years; 38% men) with severe symptomatic aortic stenosis (mean gradient 48.8± 13.6 mmHg) who underwent both 3D-TOE and MSCT as part of TAVI evaluation protocol. Volumetric datasets of the AR, acquired with 3D-TOE in mid-esophageal view, were analyzed with EV tool. EV tool automatically detected AR landmarks and, after user validation, created 3D model of AR providing values of area, perimeter, diameters of aortic annulus (AA) and coronary ostia heights (Fig 1). Results EV tool analysis on 3D-TOE volumetric data sets was feasible in all patients. Strong correlation between EV tool and MSCT assessment for AA major diameter (r = 0.79), AA minor diameter (r = 0.81), AA perimeter (r = 0.89) and AA area (r = 0.89) (all p< 0.0001) was found. On average EV tool underestimated MSCT measurements of AA major diameter (1.2 mm, 4.5%), AA minor diameter (2.6 mm, 11.3%), AA perimeter (4 mm, 5.2%) and AA area (65.3 mmq, 13.6%). Moderate correlation between the two methods, already in this initial sample, for right coronary artery ostium height (r = 0.53, p = 0.007) was discovered. Finally, weak correlation for left coronary artery ostium height (r = 0.33, p = 0.1) was revealed. EV tool measurements from two different volumetric datasets of the same patient showed an excellent reproducibility intraclass correlation coefficient (ICC) for AA area 0.94 and ICC for right coronary height 0.98. Conclusion With these initial results EV tool could be used in clinical practice for quick and reliable assessment of AA area, perimeter and diameters. A larger group of patients will be needed to assess the consistency of coronary ostia height evaluation by EV tool. Abstract P218 Figure. eSie Valve landmarks and 3D model of AR

Fluid Study of Transcatheter Aortic Valve Deployment Into Patients With Varying Coronary Ostia Position

2011 ◽  
Author(s):  
Eric Sirois ◽  
Qian Wang ◽  
Susheel Kodali ◽  
Wei Sun
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Cfd Simulation ◽  
Patient Specific ◽  
Coronary Ostium ◽  
Case Scenario ◽  
Element Analysis ◽  
Worst Case ◽  
Transcatheter Aortic Valve ◽  
Coronary Ostia

Recently, minimally-invasive transcatheter aortic valve (TAV) replacement has emerged as a viable alternative to traditional open-chest heart valve replacement for high risk patients who otherwise have limited or no treatment options. Although significant experience with TAV procedures has been gained, various adverse effects have been observed after device implantation [1, 2]. One adverse event is the impairment of coronary artery flow. Because the TAV stent pushes the native leaflets towards the sinus of Valsalva during TAV deployment, the flow boundaries in the aortic root are consequently altered. A worst case scenario would be the occlusion of the coronary ostia. Reduced flow to the coronary arteries has also been observed for some patients following TAV intervention [3]. With IRB approval, we recently conducted a dimensional analysis of 3D aortic root geometries, reconstructed from 64-slice CT scans of 95 patients [4]. TAV-relevant dimensions were measured. The spatial distribution of the left coronary ostium was quantified (Fig. 1). In this study, we will construct a patient-specific aortic root model with varied coronary ostium locations as shown in Fig. 1, and perform a combined finite element analysis (FEA) and computational fluid dynamics (CFD) simulation to investigate hemodynamic environment changes that occur following TAV intervention.

scholarly journals Self-navigated MRI 3D whole heart sequence for non-enhanced aortic root measurement in transcatheter aortic valve intervention: comparison to cardiac CT

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Holzknecht ◽  
M Pamminger ◽  
C Tiller ◽  
C Kranewitter ◽  
C Kremser ◽  
...  
Keyword(s):  
Image Quality ◽  
Aortic Valve ◽  
Lower Limit ◽  
Aortic Root ◽  
Kappa Statistics ◽  
Transcatheter Aortic Valve ◽  
Upper Limit ◽  
Significant Difference ◽  
Coronary Ostia ◽  
Whole Heart

Abstract Purpose To evaluate image quality, inter-observer reliability and diagnostic accuracy of self-navigated noncontrast 3D whole-heart magnetic resonance angiography (MRA) for transcatheter aortic valve intervention (TAVI) evaluation in comparison to standardized contrast-enhanced computed tomography angiography (CTA). Methods Whole-heart 1.5 T MRA was performed in 33 patients (aged 84 years [IQR 79–86], 48% male) for aortic root sizing and measurements of coronary ostia heights. A subgroup of 18 (55%) patients underwent additional CTA as gold standard for TAVI measurements. Image quality was assessed by a 4-point Likert scale, continuous MRA and CTA measurements were compared with regression and Bland-Altman analysis, valve sizing by kappa statistics. Results Median image quality of MRA as rated by two observers according was 1.5 [IQR 1.5–2.5]. In 4 patients (12%) one coronary ostium each (right coronary artery 3, left main artery 1) was not clearly definable on MRA. Inter-observer correlation was substantial to excellent (r=0.61 to 0.92) with a bias of 19 mm2 for annulus area (lower limit of agreement −59 mm2, upper limit of agreement 98 mm2; p=0.009). Aortic root and ostia height measurements by MRA and CTA showed substantial to excellent correlation (r=0.65 to 0.90) with no significant bias (all p≥0.333). Mean annulus area for MRA was 414±71 mm2 and for CTA 422±80 mm2 (r=0.9) with a bias of −8 mm2 (lower limit of agreement −79 mm2, upper limit of agreement −62 mm2; p=0.333). Regarding prosthetic valve sizing there was complete consistency between MRA and CTA-based decisions (κ=1). Conclusion Self-navigated noncontrast 3D whole-heart MRA enables reliable aortic root TAVI measurements without significant difference to standardized CTA. Prosthesis sizing by MRA measurements would completely match to CTA-based choice. However, in some cases coronary ostia may be difficult to define. Funding Acknowledgement Type of funding source: None

scholarly journals Coronary Ostia Stenosis After Transcatheter Aortic Valve Implantation

2010 ◽  
Vol 3 (2) ◽  
pp. 253-255 ◽  
Author(s):  
Rodrigo Bagur ◽  
Eric Dumont ◽  
Daniel Doyle ◽  
Eric Larose ◽  
Jerôme Lemieux ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Coronary Ostia ◽  
Valve Implantation

scholarly journals The Use of BASILICA Technique to Prevent Coronary Obstruction in a TAVI-TAVI Procedure

2021 ◽  
Vol 10 (23) ◽  
pp. 5534
Author(s):  
Ana Paula Tagliari ◽  
Rodrigo Petersen Saadi ◽  
Eduardo Ferreira Medronha ◽  
Eduardo Keller Saadi
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve ◽  
Aortic Valve Implantation ◽  
Coronary Ostia ◽  
Valve Implantation ◽  
Artery Obstruction ◽  
Coronary Obstruction

Transcatheter aortic valve implantation (TAVI) to manage structural bioprosthetic valve deterioration has been successful in mitigating the risk of a redo cardiac surgery. However, TAVI-in-TAVI is a complex intervention, potentially associated with feared complications such as coronary artery obstruction. Coronary obstruction risk is especially high when the previously implanted prosthesis had supra-annular leaflets and/or the distance between the prosthesis and the coronary ostia is short. The BASILICA technique (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) was developed to prevent coronary obstruction during native or valve-in-valve interventions but has now also been considered for TAVI-in-TAVI interventions. Despite its utility, the technique requires a not so widely available toolbox. Herein, we discuss the TAVI-in-TAVI BASILICA technique and how to perform it using more widely available tools, which could spread its use.

scholarly journals Transcatheter Aortic Valve Deployment: Interactions Between Native Leaflets and Coronary Ostia

2009 ◽  
Vol 3 (2) ◽  
Author(s):  
J. L. Quill ◽  
A. G. Geeslin ◽  
P. A. Iaizzo
Keyword(s):  
Aortic Valve ◽  
Coronary Flow ◽  
Vessel Wall ◽  
Contrast Injection ◽  
Video Footage ◽  
Transcatheter Aortic Valve ◽  
Aortic Leaflet ◽  
Left And Right ◽  
Coronary Ostia ◽  
3D Digitizing

During the delivery of a transcatheter aortic valve, the native leaflets are pressed toward the vessel wall when the stented valve is deployed, but the proximity of the native leaflets to the coronary ostia following deployment is not fully understood. Fluoroscopic (F) and endoscopic (E) video footage was gathered from isolated human hearts (n=3). Balloon valvuloplasty (BAV) was performed with a non-compliant balloon, followed by contrast injection into the coronary ostia. Images (F) captured the perpendicular distance from the balloon to the ostia (ostium depth). A nitinol stent was delivered to the aortic position trans-apically. Images (E) measured the distance between the native aortic leaflet and the lowest point of the coronary ostium (ostium height). Additionally, cadaveric hearts (n=23) underwent extensive anatomical analyses using a 3D digitizing arm in addition to the described procedures. BAV in perfusion fixed hearts gave left and right ostium depths of 5.28±1.49 and 5.34±1.85. Images (E) from the perfusion fixed human hearts showed left and right ostium heights of 3.2±2.9 mm and 4.3±2.4, respectively. 2 of the 23 perfusion fixed human hearts studied had negative ostia heights, but the effect on coronary flow is not known.

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