Author + information
- Received January 9, 2012
- Revision received March 13, 2012
- Accepted March 14, 2012
- Published online May 1, 2012.
- Vinayak N. Bapat, FRCS.CTh,
- Rizwan Q. Attia, MRCS⁎ ( and )
- Martyn Thomas, FRCP
- ↵⁎Reprint requests and correspondence:
Mr. Vinayak Bapat, Department of Cardiothroacic Surgery, 6th Floor East Wing, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom
Objectives This study sought to identify how many patients suitable for transcatheter aortic valve implantation (TAVI) would have a contraindication for the transaortic (TAo) approach due to ascending aortic calcification.
Background TAo is an emerging approach for implantation of the Sapien valve through the ascending aorta. A “porcelain aorta” is often considered a contraindication for the TAo approach. This may not always be true, as the TAo procedure requires a small calcium-free area for the purse-string suture, usually in the upper outer quadrant of the distal ascending aorta, identified as the “TAo zone.”
Methods A total of 237 patients underwent TAVI between February 2008 and June 2011. Multislice computed tomography scans (MSCT) were analyzed for distribution of calcium with special attention to the TAo zone. Each MSCT was interrogated in cross section and three dimensional (3D) reconstructions. Correlation between the calcium distribution on MSCT and the 3D reconstruction with the clinical findings was sought in patients undergoing the TAo procedure.
Results The vast majority of patients had calcification in the aortic arch (n = 154, 64.9%) and aortic root (n = 220, 92.8%). Of the 237 patients, only 1 patient had diffuse calcification in the ascending aorta, including the TAo zone, thus precluding a TAo procedure. MSCT and 3D reconstruction data in the 33 patients who underwent a TAo procedure, including 6 who were identified as having porcelain aorta preoperatively, correlated very well with the absence of calcium in the TAo zone during surgery. There were no post-procedure neurological events in this group.
Conclusions Conventionally defined porcelain aorta should not be considered a contraindication for performing TAVI by the TAo approach.
Funding was provided by an educational grant from the NIHR Biomedical Research Council, United Kingdom. Mr. Bapat is a consultant for Edwards Lifesciences, Inc. and Medtronic, Inc. Dr. Thomas is a proctor and consultant for Edwards Lifesciences, Inc. Dr. Attia has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received January 9, 2012.
- Revision received March 13, 2012.
- Accepted March 14, 2012.
- 2012 American College of Cardiology Foundation