title: Identification of Coronary Artery Orifice to Prevent Coronary Complications in Bioprosthetic and Transcatheter Aortic Valve Replacement.
abstract: BACKGROUND
  The aim of this study was to identify anatomical variations in coronary artery orifices among high-risk patients with a small aortic root undergoing bioprosthetic aortic valve replacement (BAVR) and transcatheter aortic valve replacement (TAVR) in order to prevent coronary orifice obstruction perioperatively.
  
  
  RESULTS
  Coronary orifice and root structure were identified in 400 patients using aortic multidetector-row computed tomography (MDCT). We measured the aortic root diameter; intercommissural distances; and distance from coronary orifice to valve annulus, commissure, and sinotubular junction. We examined positional relationships between the coronary orifice and stent post, or sewing cuff of the bioprosthetic valve and leaflet of the transcatheter aortic valve. Most left coronary artery orifices were distributed near the center of the non-left and left-right commissures; right ones were relatively distributed on the non-right commissural side. Thirty-four patients (8.5%) with BAVR (coronary orifice near the commissure: 31, 7.8%; low takeoff: 5, 1.3%; and both: 2) and 39 (9.8%) with TAVR were at risk for coronary orifice obstruction. During BAVR, one-stitch rotation of the stent and one-stitch rotation with intra-annular implantation were used in near-commissure and low takeoff cases, respectively. During TAVR, percutaneous coronary intervention may be required in the height of the coronary orifice was ≤10 mm from the base of the ventricle aortic junction.
  
  
  CONCLUSIONS
  Potential coronary complications during BAVR and TAVR in high-risk patients for coronary obstruction were identified using preoperative aortic MDCT. Choice of appropriate surgical technique or valve is essential.
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East.
authors.forename: Wataru
authors.initials: W
authors.lastname: Tatsuishi
authors.forename: Kiyoharu
authors.initials: K
authors.lastname: Nakano
authors.forename: Sayaka
authors.initials: S
authors.lastname: Kubota
authors.forename: Ryota
authors.initials: R
authors.lastname: Asano
authors.forename: Go
authors.initials: G
authors.lastname: Kataoka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001705:Bioprosthesis; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000517:prevention & control; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*