Coronary Access and Perfusion Following Transcatheter Aortic Valve Replacement: The Effects of Relative Coronary Ostium Positioning

Abstract With the goal of commissural alignment becoming a major goal with transcatheter aortic valve replacement (TAVR) becoming more prevalent, the native positionings of the coronary ostia and aortic valve cusps should be considered in the pre-procedural planning. Coronary access and perfusion post-TAVR are paramount to a patient's long-term outcomes with such procedures. In certain cases of unsymmetrical coronary cusps, commissural alignment may still leave a particularly eccentric coronary, that lays close to the native commissure of the valve, which is then susceptible to coronary obstruction. The Visible Heart® Laboratories have access to over 600 human heart specimens that have been used to analyze the native positionings of the coronary ostia. These specimens have been micro-CT scanned to make 3D-computational models with resolutions ranging from 80-100 microns. Additionally, reanimated swine hearts have been utilized to assess the relative effects of TAVR on coronary perfusion and access in living tissues. To do so, coronary pressure wires have been placed in these swine hearts before and after TAVR to assess how the coronary position could affect coronary perfusion following TAVR. The data collected here should be an educational aid to those performing such procedures as well as those developing the technologies to do so.