Assessing Potential Risks of Future Redo Transcatheter Aortic Valve Replacement in Asian Patients

Figures

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  Figure 1. Study Workflow Flowchart providing information about the included and excluded patients. CABG = coronary artery bypass grafting; CT = computed tomographic; TAVR = transcatheter aortic valve replacement.

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  Central Illustration. Coronary Obstruction Risk in Redo TAVR Simulated by CT (Top panel) Definition of coronary obstruction risk of sinus of Valsalva (SOV) sequestration in computed tomography (CT)–simulated redo transcatheter aortic valve replacement (TAVR). (Bottom panel) Incidence comparison of coronary obstruction risk caused by sequestering the SOV for each coronary artery in CT-simulated redo TAVR between the balloon-expandable (BE) transcatheter aortic valve (TAV) and self-expanding (SE) TAV groups. LCA = left coronary artery; RCA = right coronary artery; STJ = sinotubular junction.

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  Figure 2. Representative Computed Tomographic Images With Coronary Obstruction Risk Representative computed tomographic images with potential sinus of Valsalva sequestration risk in redo transcatheter aortic valve replacement in the balloon-expandable (BE) transcatheter aortic valve (TAV) group (top panels) and the self-expanding (SE) TAV group (bottom panels) are shown. In the long-axis image, the distance from the inflow of the TAV to the sinotubular junction (STJ) in each coronary sinus was measured. In patients with TAV commissure levels above the STJ, the horizontal distance from the TAV to the STJ was measured in the short-axis view.

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  Figure 3. Feasibility of Future Redo TAV Replacement in the BE TAV Group In 472 patients with TAV commissure levels located above the STJ, TAV-to-STJ distances <2.0 mm were observed in 392 patients (83.1%) for 1 or both coronary sinuses in the BE TAV group. Abbreviations as in Figure 2.

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  Figure 4. Feasibility of Future Redo TAV Replacement in the SE TAV Group In 305 patients with TAV commissure levels located above the STJ, TAV-to-STJ distances <2.0 mm were observed in 236 patients (77.4%) for 1 or both coronary sinuses in the SE TAV group. Abbreviations as in Figure 2.

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  Figure 5. Coronary Obstruction Risk in Redo TAV Replacement by Baseline TAV Sizes (A) Small baseline TAVs (20- and 23-mm BE TAVs and 23-mm SE BAVs), (B) medium-sized baseline TAVs (26-mm BE TAVs and 26-mm SE TAVs), and (C) large baseline TAVs (29-mm BE TAVs and 29- and 34-mm SE TAVs). LCA = left coronary artery; RCA = right coronary artery; other abbreviations as in Figure 2.