Effect of conventional and rapid-deployment aortic valve replacement on the distance from the aortic annulus to coronary arteries

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.

Keywords: Coronary height; Coronary occlusion; Rapid-deployment aortic valve replacement; Valve-in-valve.

© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Figures

Figure 1:

HeartNavigator system computed tomography assessment of the coronary heights before and after implantation of the RD-AV EDWARDS INTUITY System. (A) Preoperative height of the RCAA—red circle and LCAA—blue circle (distance from the annular plane to left the coronary ostium). (B) Postoperative height of the RCAA—red circle and LCAA—blue circle (distance from the annular plane to the right coronary ostium). LCAA: left coronary artery-to-annulus; RCAA: right coronary artery-to-annulus.

Figure 2:

HeartNavigator system computed tomography assessment of the coronary heights before and after implantation of the sutured Edwards Magna Ease. (A) Preoperative height of the RCAA—red circle and LCAA—blue circle (distance from the annular plane to the left coronary ostium). (B) Postoperative height of the RCAA—red circle and LCAA—blue circle (distance from the annular plane to the right coronary ostium). LCAA: left coronary artery-to-annulus; RCAA: right coronary artery-to-annulus.

Figure 3:

Mean coronary distances from the annular plane to the coronary ostium at baseline (first bar of each group of 4 bars) and postoperatively (second bar of each group of 4 bars) for the right coronary artery (green) and left coronary artery (yellow) after sutured aortic valve replacement (the first groups of 2 bars on the left side) and rapid-deployment valve implantation (the next groups of 2 bars on the right side). The sutured group showed a significant decrease in the coronary-to-sewing ring height for both the right coronary (P < 0.0001) and left coronary (P < 0.0001) arteries compared with rapid-deployment valve group.