Valve-in-valve TAVI and risk of coronary obstruction: Validation of the VIVID classification

Daijiro Tomii; Taishi Okuno; Jonas Lanz; Stefan Stortecky; David Reineke; Stephan Windecker; Thomas Pilgrim

doi:10.1016/j.jcct.2023.01.042

Valve-in-valve TAVI and risk of coronary obstruction: Validation of the VIVID classification

J Cardiovasc Comput Tomogr. 2023 Mar-Apr;17(2):105-111. doi: 10.1016/j.jcct.2023.01.042. Epub 2023 Feb 6.

Authors

Daijiro Tomii¹, Taishi Okuno², Jonas Lanz³, Stefan Stortecky³, David Reineke⁴, Stephan Windecker³, Thomas Pilgrim⁵

Affiliations

¹ Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. Electronic address: https://twitter.com/@DaijiroTomii.
² Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. Electronic address: https://twitter.com/@taishiokuno.
³ Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
⁴ Department of Cardiac Surgery, Inselspital, University of Bern, Bern, Switzerland.
⁵ Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. Electronic address: thomas.pilgrim@insel.ch.

PMID: 36754691
DOI: 10.1016/j.jcct.2023.01.042

Abstract

Background: The Valve-in-Valve International Data (VIVID) registry proposed a simplified classification to assess the risk of coronary obstruction during valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) based on preprocedural multi-detector computed tomography (MDCT). We investigated the validity of the VIVID classification in patients undergoing ViV-TAVI for degenerated bioprostheses.

Methods: Patients undergoing ViV-TAVI for degenerated bioprostheses were prospectively included in this study. The risk of coronary obstruction among patients treated with stented valves was retrospectively evaluated based on anatomical assessment on pre-procedural MDCT.

Results: Among a total of 137 patients that underwent ViV-TAVI between August 2007 and June 2021, 109 patients had stented, sutureless, or transcatheter degenerated bioprosthesis of which 96 (88%) had adequate MDCT data for risk assessment. High-risk anatomy for coronary obstruction (VIVID type IIB, IIIB, or IIIC) in either the left or right coronary artery was observed in 30 patients (31.3%). Of the 30 patients with high-risk anatomy, coronary protection using wire protection or BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) was performed in 3 patients (10.0%). Three patients treated with stentless valves and one patient treated with a stented valve with externally mounted leaflets had coronary obstruction. None of the patients with high risk anatomy according to MDCT had coronary obstruction even without coronary protection.

Conclusions: Coronary obstruction occurred in none of the patients classified as high-risk patients according to the VIVID classification despite the absence of coronary protection. Refined tools are required to assess the risk of coronary obstruction.

Clinical trial registration: https://www.

Clinicaltrials: gov. NCT01368250.

Keywords: Aortic stenosis; Coronary obstruction; Transcatheter aortic valve implantation; VIVID.

Publication types

Clinical Trial

MeSH terms

Aortic Valve / diagnostic imaging
Aortic Valve / surgery
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / etiology
Aortic Valve Stenosis* / surgery
Bioprosthesis*
Coronary Occlusion* / etiology
Heart Valve Prosthesis*
Humans
Predictive Value of Tests
Prosthesis Design
Retrospective Studies
Transcatheter Aortic Valve Replacement* / adverse effects
Transcatheter Aortic Valve Replacement* / methods
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01368250