Author + information
- Amirsepehr Azimian,
- Scott Lilly,
- Jennifer Dollery,
- Juan Crestanello and
- Lakshmi Prasad Dasi
Coronary Obstruction (CO) occurrence during TAVR often proves fatal. Existing CO predictive parameters based on coronary height (h) and Sinus of Valsalva diameter (SOVd)(1,2) lack 3D geometric information on the aortic root and calcific lesions, and are prone to error. In this study we aim to improve predictive power by incorporating leaflet length (L), coronary artery diameter (d) and calcium nodule size (t).
The study population includes 600 patients who underwent TAVR at The Ohio State University Wexner Medical Center January 2014 to August 2017. To enrich the population in patients at higher risk of CO, patients with h > 14 mm and SOVd > 32 mm were excluded from the screening process, resulting in total 23 patients, 15 women [65.2%], aged 80 ±  years (mean ± [SD]). The standard variables (h and SOVd) along with L, d, and t were measured for all patients (Figure 1A), and the predicted Distance between the Leaflet tip and Coronary ostium after TAV deployment was calculated (Figure 1B).
CO had an incidence of 21.7% (5/23) in high-risk population equivalent to 0.83% (5/600) in total, mostly occurring in left coronary artery. The left h and SOVd were 10.7mm +- [3.9] and 30.9mm ± [4.2] respectively. The novel CO predictive parameter DLC was 0.97mm ± [0.5]. SOVd and h resulted in area under ROC curves [95% CI] = 0.24 [0.12-0.41] and 0.63 [0.41-0.82] respectively, while DLC significantly increased the area under ROC curve to 0.92 [0.74-0.99] (Figure 1C).
With this study a novel criterion was successfully developed to screen for CO during TAVR and assist cardiologists in the pre-TAVR decision-making process. Additional measurements of aortic root variables are recommended for patient at high risk of CO.
1. Ribeiro HB, et al. J Am Coll Cardiol 2013;62:1552-62.
2. Yamamoto M, et al. Int J Cardiol 2016;217:58-63.