Valvular & structural heart disease

Predicted vs Observed Valve to Coronary Distance in Valve-in-Valve Transcatheter Aortic Valve Replacement (TAVR): A Computed Tomography Study

JACC Cardiovasc IntervPublished Observational imaging study

Authors' conclusion

With nominal balloon filling, VTC and VTS distances underestimate postprocedural distances due to THV frame underexpansion. However, postdilatation may lead to distances smaller than predicted due to THV overexpansion at the outflow level.

Study context

Population
Patients undergoing balloon-expandable valve-in-valve TAVR
Participants
51 patients
Exposure
Predicted vs observed valve-to-coronary and valve-to-sinus distances
Outcome
Agreement of predicted VTC and VTS distances with observed post-TAVR anatomy on CT, and relation to THV expansion and deployment conditions

Main finding

As reported in the abstract

Observed THV-to-coronary ostia distance minus predicted VTC distance

Nominal balloon filling

1.25

mean difference · SD 1.28 · mm

Postdilatation

−0.45

mean difference · SD 0.52 · mm

Observational data: associations, not effects.

Further findings

OutcomeP value
THV stent frame expansionGreater expansion at all 4 THV levelsP < 0.001

Transcatheter heart valve (THV) stent frame expansion

THV frame flared toward outflow but generally underexpanded at all levels, particularly at surgical heart valve (SHV) sewing ring

Original publication

Predicted vs Observed Valve to Coronary Distance in Valve-in-Valve TAVR: A Computed Tomography Study. JACC Cardiovasc Interv. Published 19 July 2023. doi:10.1016/j.jcin.2023.05.038

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