TY - JOUR JO - EuroIntervention TI - A computed tomography study of coronary access and coronary obstruction after redo transcatheter aortic valve implantation AB - <p><strong>Aims: </strong>to investigate the risk of impaired coronary access and coronary obstruction after REDO-TAVI.</p> <p><strong>Methods and Results: </strong>Post-procedure multi-detector computed tomography (MDCT) scans of 221 TAVI recipients were analyzed. Increased risk of impaired coronary access was defined as coronary ostium below TAVI commissures with valve-to-aorta distance &lt;2mm at this level. Increased risk was found in 123 (55.6%) cases, the left main involved in 109 (49.3%), the right coronary in 79 (35.7%), both in 65 (29.4%) patients. Small sino-tubular junction (STJ width OR 0.68, CI 0.56-0.81, P&lt;0.001; STJ height OR 0.81, CI 0.69-0.95, P&lt;0.011) and supra-annular devices (OR 19.8, CI 6.6-58.8, P&lt;0.001) predicted increased risk. Increased risk of coronary obstruction defined as coronary ostium below TAVI commissures with valve-to-coronary distance &lt;2mm was observed in 14.9% of patients, and in 17.2% of cases complete sealing of STJ would occur.</p> <p><strong>Conclusions:</strong> Post-TAVI MDCT suggested an increased potential risk of impaired coronary access in more than half of patients should REDO-TAVI be required, predicted by small STJ and supra-annular device design. Furthermore, 10-20% of patients presented an increased risk of coronary obstruction. While this theoretical study is hypothesis-generating, it raises concerns that need to be further investigated and addressed before TAVI is extended to patients with longer life expectancy.</p> AU - Buzzatti Nicola AU - Montorfano Matteo AU - Romano Vittorio AU - De Backer Ole AU - Søndergaard Lars AU - Rosseel Liesbeth AU - Maurovich-Horvat Pal AU - Karady Julia AU - Merkely Béla AU - Prendergast P. Bernard AU - De Bonis Michele AU - Colombo Antonio AU - Latib Azeem VL - IS - Y1 - 15/09/2020 Y1 - 2020 DOI - 10.4244/EIJ-D-20-00475 SP - KW - coronary artery disease KW - tavi KW - coronarry occlusion PB - Europa Digital & Publishing UR - https://eurointervention.pcronline.com/article/a-computed-tomography-study-of-coronary-access-and-coronary-obstruction-after-redo-transcatheter-aortic-valve-implantation SN - 1774-024X ER -