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Preoperative Multi-Detector Computed Tomography for Isolated Surgical Aortic Valve Replacement; Planning for Future Transcatheter Options
  • +6
  • Craig Basman,
  • Karthik Seetharam,
  • Joel Johnson,
  • Jonathan Hemli,
  • Derek Brinster,
  • Nirav Patel,
  • S Scheinerman,
  • Chad Kliger,
  • Luigi Pirelli
Craig Basman
Lenox Hill Hospital
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Karthik Seetharam
Lenox Hill Hospital
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Joel Johnson
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Jonathan Hemli
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Derek Brinster
Lenox Hill Hospital
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Nirav Patel
Lenox Hill Hospital
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S Scheinerman
Lenox Hill Hospital
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Chad Kliger
Lenox Hill Hospital
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Luigi Pirelli
Lenox Hill Hospital
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Peer review status:IN REVISION

05 Jun 2020Submitted to Journal of Cardiac Surgery
08 Jun 2020Submission Checks Completed
08 Jun 2020Assigned to Editor
15 Jun 2020Reviewer(s) Assigned
29 Jun 2020Review(s) Completed, Editorial Evaluation Pending
06 Jul 2020Editorial Decision: Revise Major
08 Jul 20201st Revision Received
10 Jul 2020Assigned to Editor
10 Jul 2020Submission Checks Completed

Abstract

ABSTRACT: Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has become a valuable option in patients with bioprosthetic failure. However, potential issues with ViV TAVR may occur in patients with high risk anatomy for coronary obstruction and patients with baseline smaller bioprosthetic valves at risk for patient prosthesis mismatch. The purpose of this study was therefore to use preoperative electrocardiography (ECG)-gated, multidetector computed tomography (MDCT) in patients undergoing isolated surgical aortic valve replacement (SAVR) to 1) identify which would be high risk for coronary occlusion with ViV TAVR, and 2) predict intraoperative SAVR sizing. Methods: Among 223 patients from our institutions’ database that underwent SAVR for aortic insufficiency (AI) or aortic stenosis (AS) between January 2012 and January 2020, 48 patients had MDCT imaging prior to surgery (AI; n=31, AS; n=17). Of all patients, 67% (n=32) were bicuspid morphology. Results: With the use of virtual valve implantation, all patients with AI and bicuspid AS had feasible anatomy for ViV TAVR, while 38% of patients with tricuspid AS were high risk for coronary obstruction. There was a strong correlation between actual valve size implanted and preoperative MDCT measurements using annulus average diameter, area and/or perimeter. Conclusion: Preoperative MDCT in patients undergoing SAVR is a useful tool for lifetime management, particularly in patients with tricuspid AS. Decisions for surgical management may change based on MDCT’s ability to predict intraoperative SAVR size and determine which patients may be high risk candidates for future ViV TAVR due to coronary artery obstruction.