Introduction:
Though the use of electrocardiography (ECG)-gated, multidetector
computed tomography (MDCT) imaging is standard to determine if a patient
with bioprosthetic aortic valve failure is a candidate for
valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR),
there is no recommendation for the use of preoperative MDCT for patients
undergoing surgical aortic valve replacement (SAVR). Patients with
bioprosthetic valve failure are frequently at high surgical risk for
reoperation, which is why ViV TAVR has become a valuable option in such
patients. (1) Due to the risk of coronary obstruction, there is a subset
of patients not amenable to standard ViV TAVR without the use of
advanced adjunctive techniques, such as chimney stenting or leaflet
laceration (which both pose additional risks). (2, 3) Additionally,
patients with smaller surgical prostheses may be predisposed to higher
gradients post-ViV TAVR, which is associated with worsened quality of
life and higher mortality rates. (4, 5) As further emphasis is placed on
lifetime management of these patients, it is therefore important that we
identify high-risk patients for successive procedures prior to initial
surgical intervention. The purpose of this study was therefore 1)
identify which patients undergoing SAVR would be high risk for ViV TAVR
coronary occlusion based on MDCT, 2) use annular measurements on MDCT to
predict intraoperative SAVR sizing.