Introduction:
Though the use of electrocardiography (ECG)-gated, multidetector computed tomography (MDCT) imaging is standard to determine if a patient with bioprosthetic aortic valve failure is a candidate for valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR), there is no recommendation for the use of preoperative MDCT for patients undergoing surgical aortic valve replacement (SAVR). Patients with bioprosthetic valve failure are frequently at high surgical risk for reoperation, which is why ViV TAVR has become a valuable option in such patients. (1) Due to the risk of coronary obstruction, there is a subset of patients not amenable to standard ViV TAVR without the use of advanced adjunctive techniques, such as chimney stenting or leaflet laceration (which both pose additional risks). (2, 3) Additionally, patients with smaller surgical prostheses may be predisposed to higher gradients post-ViV TAVR, which is associated with worsened quality of life and higher mortality rates. (4, 5) As further emphasis is placed on lifetime management of these patients, it is therefore important that we identify high-risk patients for successive procedures prior to initial surgical intervention. The purpose of this study was therefore 1) identify which patients undergoing SAVR would be high risk for ViV TAVR coronary occlusion based on MDCT, 2) use annular measurements on MDCT to predict intraoperative SAVR sizing.