Iuliana Coti1, Udo Maierhofer1, Claus Rath2, Paul Werner1, Christian Loewe3, Alfred Kocher1, Guenther Laufer1, Martin Andreas1. 1. Division of Surgery, Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. 2. Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria. 3. Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Abstract
OBJECTIVES: This study aimed to compare the effect of surgical aortic valve replacement (SAVR) on coronary height in patients undergoing SAVR with rapid-deployment or SAVR with several standard sutured bioprostheses. This study may identify patients at higher risk of coronary obstruction during valve-in-valve procedures. METHODS: We analysed 112 patients [mean age 71 (9 SD) years] who underwent SAVR with either a rapid-deployment aortic bioprosthesis (EDWARDS INTUITY Elite Valve) or other standard sutured biological valves. The coronary heights were assessed by computed tomography scan with the Philips 3D HeartNavigator system. RESULTS: Two groups of patients were analysed: 51 (45.5%) patients implanted with an RD-AVR, which is a supra-annular valve that requires 3 anchoring sutures without the use of pledgets, and 61 (54.5%) patients implanted with a conventional supra-annular sutured bioprosthesis. The mean right and left coronary artery-to-annulus (RCAA and LCAA) heights at baseline were 16.9 (4.6 SD) and 14.2 (4.0 SD) mm in the standard sutured group and 16.3 (3.5 SD) and 12.8 (2.9 SD) mm in the RD-AVR group, respectively; a significantly shorter distance was observed for the left coronary artery in the rapid-deployment group (P = 0.420 for RCAA height and P = 0.044 for LCAA). Postoperatively, the mean RCAA and LCAA heights were significantly decreased in both groups compared to baseline. A mean of 11.5 (4.8 SD) mm for the RCAA and 7.9 (4.3 SD) mm for the LCAA in the standard sutured group as well as 14.4 (3.9 SD) mm for the RCAA and 9.0 (3.1 SD) mm for the LCAA in the RD-AVR group were observed (P < 0.001 for RCAA and LCAA in both the sutured and rapid-deployment groups). Despite the significant difference in the mean distance from the left coronary artery to annulus between the groups at baseline, the postoperative mean distance of the LCAA to the sewing ring was still higher in the RD-AVR group. CONCLUSIONS: A significantly shorter coronary artery-to-aortic annulus distance for both the right and left main coronary arteries was observed after AVR with different conventional sutured supra-annular bioprostheses compared to AVR with rapid-deployment valves. These findings might be relevant for bioprosthesis selection, especially for young patients.
OBJECTIVES: This study aimed to compare the effect of surgical aortic valve replacement (SAVR) on coronary height in patients undergoing SAVR with rapid-deployment or SAVR with several standard sutured bioprostheses. This study may identify patients at higher risk of coronary obstruction during valve-in-valve procedures. METHODS: We analysed 112 patients [mean age 71 (9 SD) years] who underwent SAVR with either a rapid-deployment aortic bioprosthesis (EDWARDS INTUITY Elite Valve) or other standard sutured biological valves. The coronary heights were assessed by computed tomography scan with the Philips 3D HeartNavigator system. RESULTS: Two groups of patients were analysed: 51 (45.5%) patients implanted with an RD-AVR, which is a supra-annular valve that requires 3 anchoring sutures without the use of pledgets, and 61 (54.5%) patients implanted with a conventional supra-annular sutured bioprosthesis. The mean right and left coronary artery-to-annulus (RCAA and LCAA) heights at baseline were 16.9 (4.6 SD) and 14.2 (4.0 SD) mm in the standard sutured group and 16.3 (3.5 SD) and 12.8 (2.9 SD) mm in the RD-AVR group, respectively; a significantly shorter distance was observed for the left coronary artery in the rapid-deployment group (P = 0.420 for RCAA height and P = 0.044 for LCAA). Postoperatively, the mean RCAA and LCAA heights were significantly decreased in both groups compared to baseline. A mean of 11.5 (4.8 SD) mm for the RCAA and 7.9 (4.3 SD) mm for the LCAA in the standard sutured group as well as 14.4 (3.9 SD) mm for the RCAA and 9.0 (3.1 SD) mm for the LCAA in the RD-AVR group were observed (P < 0.001 for RCAA and LCAA in both the sutured and rapid-deployment groups). Despite the significant difference in the mean distance from the left coronary artery to annulus between the groups at baseline, the postoperative mean distance of the LCAA to the sewing ring was still higher in the RD-AVR group. CONCLUSIONS: A significantly shorter coronary artery-to-aortic annulus distance for both the right and left main coronary arteries was observed after AVR with different conventional sutured supra-annular bioprostheses compared to AVR with rapid-deployment valves. These findings might be relevant for bioprosthesis selection, especially for young patients.
Authors: Cary W Akins; D Craig Miller; Marko I Turina; Nicholas T Kouchoukos; Eugene H Blackstone; Gary L Grunkemeier; Johanna J M Takkenberg; Tirone E David; Eric G Butchart; David H Adams; David M Shahian; Siegfried Hagl; John E Mayer; Bruce W Lytle Journal: Eur J Cardiothorac Surg Date: 2008-03-04 Impact factor: 4.191
Authors: Helmut Baumgartner; Volkmar Falk; Jeroen J Bax; Michele De Bonis; Christian Hamm; Per Johan Holm; Bernard Iung; Patrizio Lancellotti; Emmanuel Lansac; Daniel Rodriguez Muñoz; Raphael Rosenhek; Johan Sjögren; Pilar Tornos Mas; Alec Vahanian; Thomas Walther; Olaf Wendler; Stephan Windecker; Jose Luis Zamorano Journal: Eur Heart J Date: 2017-09-21 Impact factor: 29.983
Authors: Uri Landes; Danny Dvir; Wolfgang Schoels; Christopher Tron; Stephan Ensminger; Matheus Simonato; Ulrich Schäfer; Matjaz Bunc; Gabriel S Aldea; Alfredo Cerillo; Stephan Windecker; Antonio Marzocchi; Martin Andreas; Nicolas Amabile; John Webb; Ran Kornowski Journal: EuroIntervention Date: 2019-05-20 Impact factor: 6.534
Authors: John G Webb; Michael J Mack; Jonathon M White; Danny Dvir; Philipp Blanke; Howard C Herrmann; Jonathon Leipsic; Susheel K Kodali; Raj Makkar; D Craig Miller; Philippe Pibarot; Augusto Pichard; Lowell F Satler; Lars Svensson; Maria C Alu; Rakesh M Suri; Martin B Leon Journal: J Am Coll Cardiol Date: 2017-05-09 Impact factor: 24.094
Authors: Danny Dvir; John G Webb; Sabine Bleiziffer; Miralem Pasic; Ron Waksman; Susheel Kodali; Marco Barbanti; Azeem Latib; Ulrich Schaefer; Josep Rodés-Cabau; Hendrik Treede; Nicolo Piazza; David Hildick-Smith; Dominique Himbert; Thomas Walther; Christian Hengstenberg; Henrik Nissen; Raffi Bekeredjian; Patrizia Presbitero; Enrico Ferrari; Amit Segev; Arend de Weger; Stephan Windecker; Neil E Moat; Massimo Napodano; Manuel Wilbring; Alfredo G Cerillo; Stephen Brecker; Didier Tchetche; Thierry Lefèvre; Federico De Marco; Claudia Fiorina; Anna Sonia Petronio; Rui C Teles; Luca Testa; Jean-Claude Laborde; Martin B Leon; Ran Kornowski Journal: JAMA Date: 2014-07 Impact factor: 56.272
Authors: Günther Laufer; Axel Haverich; Martin Andreas; Friedrich W Mohr; Thomas Walther; Malakh Shrestha; Parwis Rahmanian; David Holzhey; Matthias Roth; Christoph Schmitz; René Schramm; Christophe Giot; Thorsten C W Wahlers Journal: Eur J Cardiothorac Surg Date: 2017-08-01 Impact factor: 4.191