International Society For Minimally Invasive Cardiothoracic Surgery

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Coronary Ostia Evaluation For Tavi <:>Comparison Of Bicuspid Vs. Tricuspid Aortic Valve Morphotype
Shiho Naito, Niklas Neumann, Hermann Reichenspurner, Prof., Evaldas Girdauskas, Prof.
University Heart Center Hamburg, Hamburg, Germany.

Backgrounds Coronary anomalies in bicuspid aortic valve (BAV) disease have been sporadically reported. The expansion of TAVI indications into moderate- and low-risk patients´ cohorts will potentially expose a significant number of patients with bicuspid aortic valve (BAV) disease to TAVI procedures. Our aim was to evaluate the precise coronary ostial anatomy in patients with BAV vs. tricuspid aortic valve (TAV) morphotype using multi-slice computed tomography (MDCT) data. Methods A total of consecutive 319 patients who were referred for TAVI to our institution and underwent preoperative MDCT between January 2016 and March 2017 were retrospectively analyzed. Based on preoperative transesophageal echocardiography (TEE), a total of 11 patients (TAVI-BAV) were diagnosed with BAV, whereas the remaining 308 patients had TAV. Due to very limited BAV cohort, BAV patients who were referred for conventional aortic valve surgery and had preoperative MDCT were also included (non-TAVI-BAV, n=25). Using MDCT, the distance between each coronary ostium and aortic valve (AV) annulus were measured and compared in BAV vs. TAV patients. Results There was a tendency towards higher take-off of the right coronary artery ostia in the BAV cohort (i.e., 17.5 ± 4.9mm in BAV cohort vs. 16.4± 3.3mm in TAV cohort, p=0.19). The distance between left coronary ostia and AV annulus was significantly larger in BAV patients (16.2± 4.2mm vs. 13.2± 3.4mm, p=0.0002). The prevalence of RCA distance < 10mm from AV annulus was not significantly higher in BAV (6% vs 3%, p=0.317, respectively) and the same distance of LCA was not significantly higher in TAV (8% vs 17%, p=0.172, respectively). Coronary anomalies (i.e., separate LAD/LCx ostia, abnormal location of RCA/LCA ostium and single coronary artery) were significantly more common in the BAV vs. TAV cohort (i.e., 11% vs 3%, p=0.08, respectively). Conclusions Our study revealed no significant association between low take-off of coronary artery ostia and aortic valve morphology (i.e., BAV vs. TAV). Due to increased prevalence of coronary anomalies in BAV patients, precise preoperative coronary assessment is essential for planning of TAVI procedures.

Characteristics of coronary ostia
BAV (n=36)TAV (n=308)p-value
RCA distance, mm (range)17.5± 4.9 (5.3-27.3)16.4± 3.3 (5.7-29.3)0.19
RCA distance <10mm, n (%)2 (6%)8 (3%)0.317
LCA distance, mm (range)16.2± 4.2 (9.0-26.3)13.2± 3.4 (6.0-24.9)0.0002
LCA distance <10mm, n (%)3 (8%)53 (17%)0.172
Coronary anomaly4 (11%)8 (3%)0.08


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