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J Card Surg. 2014 May;29(3):371-6. doi: 10.1111/jocs.12348.

Development of a single endovascular device for aortic valve replacement and ascending aortic repair.

Author information

1
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Heart Center Freiburg University, Freiburg, Germany.

Abstract

BACKGROUND AND AIM OF THE STUDY:

Transcatheter aortic valve implantation (TAVI) is contraindicated in the presence of an ascending aortic aneurysm. Our aim was to design a composite endovascular device enabling ascending aortic repair and TAVI.

METHODS:

From 2007 to 2013, among 1196 patients with severe aortic stenosis screened for TAVI, 79 nonbicuspid patients had ascending aortic diameter >45 mm. Proximal aortic geometry was assessed in those with computed tomography angiography.

RESULTS:

All together, 51 patients (35 males, aged 85 ± 8 years; 19 TAVI, 10 open Wheat procedures, 22 managed conservatively) were included. The required annular diameter for implantation of currently available TAVI prostheses was met in 41% (21/51). Novel prosthetic valves appropriate for annular range up to 30 mm would extend device applicability to 78% (40/51). Proximal and distal diameters of the graft-covering portion ranging between 30 and 46 mm would enable 10% graft oversizing in all but six patients. In 88% (45/51) the required minimum 10 mm distance between aortic valve annulus and coronary artery ostia was found. Mean distance between left and right coronary artery ostia and sinotubular junction was 2.6 ± 1.5 and 3.2 ± 1.7 mm, respectively.

CONCLUSIONS:

Novel composite endovascular valved grafts may extend the application of transcatheter techniques to patients denied TAVI due to a concomitant ascending aneurysm. The location of coronary arteries in relation to the sinotubular junction must be addressed in designing these composite valve grafts.

PMID:
24762037
DOI:
10.1111/jocs.12348
[Indexed for MEDLINE]

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