CT-scan theoretical analysis for aortic cross-clamp and opening after transcatheter aortic valve implantation.

AIMS: TAVI expansion will imply an increase in the frequency of emergent or late cardiac surgery after THV implantation. This study was designed to investigate the anatomical feasibility of surgical cross-clamp and aortotomy after TAVI through a post-TAVI CT-scan assessment. METHODS AND RESULTS: We retrospectively analyzed 117 CTs acquired after TAVI procedures with high stent prostheses in three high-volume centers between October 2008 and May 2017. The mean distance observed between the innominate artery and the top of the transcatheter heart valve was 45 ± 11 mm, being 20 mm in 78/117 [66.7%] cases). A total of 56/117 (47.9%) patients showed a complete continuous contact between the anterior aortic wall and the anterior part of the valve stent. CONCLUSIONS: Aortic cross-clamp appears to not be an issue when cardiac surgery is needed after a TAVI, but a careful and possibly higher aortotomy may be required. CT should be performed prior to planned cardiac surgery after TAVI to determine a safe positioning for aortic cross-clamp and aortotomy.