title: Position of Edwards SAPIEN transcatheter valve in the aortic root in relation with the coronary ostia: implications for percutaneous coronary interventions.
abstract: OBJECTIVE
  To determine the implications of stable coverage of the coronary ostia by the Edwards SAPIEN valve frame in terms of myocardial ischemia and subsequent percutaneous coronary intervention (PCI), following transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  Edwards SAPIEN frame is frequently deployed relatively higher than recommended and may overlap the coronary ostia.
  
  
  METHODS
  A total of 142 patients (age 81 ± 7 years, male 49%) treated with Edwards SAPIEN valve and with multi-detector row computed tomography at 1 month follow-up were evaluated. The position of the frame in relation to the coronary ostia was assessed. Levels of troponin T were measured 12-24 hr after TAVI. PCI events at follow-up were recorded.
  
  
  RESULTS
  The left coronary ostium was fully covered in three (2.1%) patients and the right coronary ostium in 11 (7.7%). There were no differences in troponin T levels between patients with fully covered ostia versus patients with partly or non-covered ostia (0.24 (0.13-0.50) μg/L versus 0.35 (0.15-0.55) μg/L, respectively; P = 0.377). At 30 ± 15 months follow up, 10 (7%) patients underwent successful PCI. Rate of subsequent PCI was similar between patients with any covered ostium and patients with non-covered ostia [4 (7.8%) vs. 6 (6.5%), P = 0.780, respectively].
  
  
  CONCLUSIONS
  Full overlap of the coronary ostia by Edwards SAPIEN frame is infrequent and in most cases does not limit subsequent PCI.
authors.affiliation: Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Katsanos
authors.forename: Philippe
authors.initials: P
authors.lastname: Debonnaire
authors.forename: Frank
authors.initials: F
authors.lastname: van der Kley
authors.forename: Philippe J
authors.initials: PJ
authors.lastname: van Rosendael
authors.forename: Emer
authors.initials: E
authors.lastname: Joyce
authors.forename: Michiel A
authors.initials: MA
authors.lastname: de Graaf
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Arthur J H A
authors.initials: AJ
authors.lastname: Scholte
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Nina
authors.initials: N
authors.lastname: Ajmone Marsan
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D004562:Electrocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D009426:Netherlands; D062645:Percutaneous Coronary Intervention; D011474:Prosthesis Design; D012042:Registries; D013997:Time Factors; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: coronary artery disease; electron beam CT/multidetector CT; imaging; transcatheter valve implantation