Computed tomography assessment for transcatheter aortic valve in valve implantation: The vancouver approach to predict anatomical risk for coronary obstruction and other considerations

Blanke, Philipp; Soon, Jeanette; Dvir, Danny; Park, Jong Kwan; Naoum, Christopher; Kueh, Shaw Hua; Wood, David; Nørgaard, Bjarne Linde; Selvakumar, Kapilan; Ye, Jian; Cheung, Anson; Webb, John G.; Leipsic, Jonathon

doi:10.1016/j.jcct.2016.09.004

Cited by 92 publications

(52 citation statements)

References 8 publications

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“…Using multidetector CT, Blanke et. al . have reported the “Vancouver Method” for measurement of ostial height and coronary obstruction risk stratification.…”

Section: Preventionmentioning

confidence: 99%

“…The double‐oblique transverse is then moved to the level of the ostia and a region of interest drawing is placed to simulate the planned valve. Measurements can then be made to assess the distance of the planned valve to the coronary ostia and the risk of coronary obstruction . The proximity of the coronary ostia to the final position of the displaced bioprosthetic leaflets can now be anticipated.…”

Section: Preventionmentioning

confidence: 99%

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Management of coronary obstruction following transcatheter aortic valve replacement

et al. 2017

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Although occlusion of the coronary arteries during transcatheter aortic valve replacement is rare, the mortality is high. In this review, we discuss the prevention and management of this complication. Occlusion of coronary ostia is a very rare, but serious, complication of transcatheter aortic valve replacement (TAVR). Although reported as only occurring in <1% of TAVR cases, it carries a high risk of fatality, with some series reporting a mortality rate as high as 40%. We present the management of an occluded left coronary artery after a self-expanding TAVR, and review the incidence, prevention, and management of this complication.

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“…Using multidetector CT, Blanke et. al . have reported the “Vancouver Method” for measurement of ostial height and coronary obstruction risk stratification.…”

Section: Preventionmentioning

confidence: 99%

Section: Preventionmentioning

confidence: 99%

Management of coronary obstruction following transcatheter aortic valve replacement

et al. 2017

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“…There are complications to this ‘chimney technique’, such as stent entrapment, and the durability of a stent deployed in such conditions seems to be suboptimal, with an associated severe challenge in reattempting coronary interventions 32. The Vancouver group defined a measure called virtual transcatheter valve-to-coronary distance (VTC) 33. It is a computed tomography-based parameter that is calculated using the horizontal distance between the coronary ostium and the border of a virtual transcatheter device, simulating to where the surgical valve leaflet will be deflected.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve replacement in failed surgical valves

Simonato

Dvir

2019

Heart

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Aortic valve-in-valve is a less invasive alternative to surgical redo in the treatment of failed bioprosthetic valves. While only inoperable patients underwent the procedure before, operators currently offer it to those at lower risk and worldwide experience is in the thousands. Early mortality has diminished in recent analyses and improvements in symptoms and quality of life have been documented. Main considerations with aortic valve-in-valve include elevated postprocedural gradients, coronary obstruction and leaflet thrombosis. Risk factors for each of these adverse events have been described at length. Aortic valve-in-valve offers a safe and effective option in the management of failed bioprosthetic valves.

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“…There were no severe coronary lesions; however, the ostium of the right coronary artery (RCA) appeared threatened by the bioprosthetic valve leaflet (Figure A; Supporting Information Figure 1A). ECG‐gated multidetector computed tomography (CT) measured the left main coronary artery (LMCA) ostium at 7.7 mm and the RCA ostium at 7.3 mm from the bioprosthetic valve annulus with a LMCA VTC of 2 mm a RCA VTC <1 mm (Figure B) . CT also re‐demonstrated a threatened RCA ostium (Figure C).…”

Section: Case Seriesmentioning

confidence: 99%

Bioprosthetic aortic valve leaflet disruption with high energy electrocautery to prevent coronary artery obstruction during valve‐in‐valve transcatheter aortic valve replacement

Nelson

Chadderdon

Song

et al. 2018

Cathet Cardio Intervent

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Transcatheter aortic valve replacement (TAVR) is well‐established for the treatment of bioprosthetic aortic valve stenosis (AS) in high surgical risk patients. Coronary artery obstruction from displacement of the bioprosthetic valve leaflets during valve‐in‐valve (VIV) TAVR is a rare, but potentially fatal, complication. Recently, the bioprosthetic aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) procedure was developed as a method for disrupting bioprosthetic leaflets in patients undergoing VIV TAVR at high risk for coronary obstruction. This case describes a successful VIV TAVR utilizing a simplified concept of the BASILICA technique in a patient where the full procedure could not be completed.

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Computed tomography assessment for transcatheter aortic valve in valve implantation: The vancouver approach to predict anatomical risk for coronary obstruction and other considerations

Cited by 92 publications

References 8 publications

Management of coronary obstruction following transcatheter aortic valve replacement

Management of coronary obstruction following transcatheter aortic valve replacement

Transcatheter aortic valve replacement in failed surgical valves

Bioprosthetic aortic valve leaflet disruption with high energy electrocautery to prevent coronary artery obstruction during valve‐in‐valve transcatheter aortic valve replacement

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