• Taylor Sirset-Becker, Aaron Clark, James D Flaherty, Christopher K Mehta, Bradley D Allen, Patrick M McCarthy, Duc T Pham, Andrei Churyla, DasiLakshmi PrasadLPDepartment of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga., and S Christopher Malaisrie.
• Department of Biomedical Sciences, The Ohio State University College of Medicine, Columbus, Ohio.
• J. Thorac. Cardiovasc. Surg. 2024 Jun 29.

ObjectiveAortic root replacement requires construction of a composite valve-graft and reimplantation of coronary arteries. This study assessed the feasibility of valve-in-valve transcatheter aortic valve implantation after aortic root replacement.MethodsA retrospective review was conducted on 74 consecutive patients who received a composite valve-graft at a single institution from 2019 to 2021. Forty patients had bioprosthetic valves with adequate postoperative gated computed tomographic angiography scans. Computational simulations of balloon and self-expanding transcatheter valve deployments were performed. The modeled coronary distances were compared with traditional, manually measured valve-to-coronary distances.ResultsThere was a statistically significant difference in the modeled versus manual measurements of valve to coronary distances for all patients regardless of valve type or coronary artery analyzed (P < .05). Most patients are low risk for coronary obstruction per 3-dimensional modeling, including those with a valve-to-coronary distance <4 mm. Only 1 patient (2.5%) was at risk for coronary obstruction for the left coronary artery using a balloon valve. No other valve combination was considered high risk of coronary obstruction. Five patients (12.5%) were at risk for possible valve stent deformation at the outflow, due to angulation at the graft anastomosis.ConclusionsFollowing aortic root replacement, all patients were candidates for valve-in-valve procedure using 1 or both types of transcatheter heart valves. Self-expanding valves may be at higher risk for stent frame deformation at graft anastomotic lines and balloon-expandable valves may be at higher risk of coronary obstruction.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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