Comparative analysis of anatomic changes and feasibility of valve-in-valve transcatheter aortic valve replacement between Konno and Y-incision aortic root enlargement

Figures

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  The Konno procedure increases coronary access space to a greater degree compared to the Y-incision technique.

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  Figure 1. Detailed measurement of preoperative and postoperative computed tomography (CT) scans. A, Preoperative CT image with the distances from the valve center to the ostia of the right coronary artery (RCA) and left coronary artery (LCA) and the largest distance to the noncoronary cusp (NCC) (green arrows), along with the intercoronary angle (purple arc). B-D, Postoperative CT images. B, Measurement of the distances from the valve center to the ostia of the RCA and the LCA and the largest distance to the NCC (green arrows), along with the intercoronary angle (purple arc) and the angles between the prosthetic valve posts and coronary arteries (blue arcs). C, Measurement of virtual transcatheter heart valve to coronary ostium distance (VTC) to the RCA and LCA at the level of the sinus of Valsalva (SOV). D, Measurement of the virtual transcatheter heart valve to aorta distance (VTA) to the aortic wall directly above the RCA and LCA at the level of the top of the prosthetic valve posts.

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  Figure 2. Preoperative and postoperative assessment of aortic root geometry based on computed tomography (CT) scans. A-D, CT images from a patient who underwent the Konno procedure. A, Preoperative image of the sinotubular junction (STJ). B, Postoperative image of the STJ. C, Overlapping preoperative and postoperative images, illustrating geometric changes in the STJ (dotted lines: preoperative; solid lines: postoperative). D, Postoperative 3-dimensional image of the aortic root. E-H, CT images from another patient who underwent the Y-incision technique, following the same layout as in A-D. In the Konno group, there was visible enlargement on the right coronary artery (RCA) and left coronary artery (LCA) sides, whereas the Y-incision group showed enlargement primarily on the noncoronary cusp (NCC) side. LCC, Left coronary cusp; RCC, right coronary cusp.

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  Figure 3. Preoperative and postoperative assessment of coronary locations based on computed tomography (CT) scans. (A-C) CT images from the same patient who underwent the Konno procedure. A, Preoperative image of coronary locations. B, Postoperative image of coronary locations. C, Overlapping preoperative and postoperative images, illustrating the geometric changes in coronary locations (dotted lines: preoperative; solid lines: postoperative). D-F, Images from another patient who underwent the Y-incision technique, with the same layout as in A-C. The Konno procedure primarily increased the distances from the center of the valve to the right coronary artery (RCA) and left coronary artery (LCA), while the Y-incision technique mainly enlarged the distances to the noncoronary cusp (NCC) side of the sinus of Valsalva and the LCA. Postoperatively, the RCA-LCA angle from the valve center was widened in the Konno group and narrowed in the Y-incision group.