Comparative analysis of anatomic changes and feasibility of valve-in-valve transcatheter aortic valve replacement between Konno and Y-incision aortic root enlargementCentral MessagePerspective
Objective: To evaluate anatomic changes in the aortic root after different aortic root enlargement (ARE) techniques and assess the risk of coronary obstruction during future valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) procedures. Methods: In this retrospective analysis of 15 p...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-04-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250725000677 |
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| author | Jiyoung Lee, MD, PhD Hiroshi Nakanaga, MD Nobuo Tomizawa, MD, PhD Yui Okada-Nozaki, MD, PhD Yuko Okano-Kawaguchi, MD, PhD Shinichiro Fujimoto, MD, PhD Minoru Tabata, MD, PhD |
| author_facet | Jiyoung Lee, MD, PhD Hiroshi Nakanaga, MD Nobuo Tomizawa, MD, PhD Yui Okada-Nozaki, MD, PhD Yuko Okano-Kawaguchi, MD, PhD Shinichiro Fujimoto, MD, PhD Minoru Tabata, MD, PhD |
| author_sort | Jiyoung Lee, MD, PhD |
| collection | DOAJ |
| description | Objective: To evaluate anatomic changes in the aortic root after different aortic root enlargement (ARE) techniques and assess the risk of coronary obstruction during future valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) procedures. Methods: In this retrospective analysis of 15 patients who underwent bioprosthetic aortic valve replacement with ARE using either the Konno or Y-incision technique, preoperative and postoperative computed tomography CT scans were reviewed to measure annular diameter, left ventricular outflow tract (LVOT), sinus of Valsalva (SOV), sinotubular junction, and coronary ostia locations. The risk of coronary obstruction was evaluated using virtual transcatheter heart valve-to-coronary ostium distance (VTC) and transcatheter heart valve-to-aorta distance (VTA). Results: Both groups showed significant increases in annulus and SOV sizes; however, only the Konno group exhibited a significant increase in LVOT size. The distance from the valve center to the coronary ostia was significantly greater in the Konno group compared to the Y-incision group (+4.2 ± 3.5 mm for the left/right coronary artery in the Konno group vs +2.4 ± 0.6 mm in the Y-incision group). The Konno group demonstrated greater VTC and VTA, with all cases achieving VTC ≥4 mm and VTA ≥2 mm. In the Y-incision group, 33.0% had VTC <4 mm and 17.0% had VTA <2 mm. Conclusions: The Konno procedure significantly increased LVOT size and access space to the coronary ostia, reducing the risk of coronary obstruction during future ViV-TAVR. These findings suggest that the Konno procedure may provide more favorable conditions compared to the Y-incision in such cases. |
| format | Article |
| id | doaj-art-9785c8d89396483e8a96f98f7e5ef2f4 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-9785c8d89396483e8a96f98f7e5ef2f42025-08-20T03:36:42ZengElsevierJTCVS Techniques2666-25072025-04-0130324210.1016/j.xjtc.2025.02.001Comparative analysis of anatomic changes and feasibility of valve-in-valve transcatheter aortic valve replacement between Konno and Y-incision aortic root enlargementCentral MessagePerspectiveJiyoung Lee, MD, PhD0Hiroshi Nakanaga, MD1Nobuo Tomizawa, MD, PhD2Yui Okada-Nozaki, MD, PhD3Yuko Okano-Kawaguchi, MD, PhD4Shinichiro Fujimoto, MD, PhD5Minoru Tabata, MD, PhD6Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, JapanDepartment of Cardiovascular Surgery, Toranomon Hospital, Tokyo, JapanDepartment of Radiology, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan; Address for reprints: Minoru Tabata, MD, PhD, Department of Cardiovascular Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.Objective: To evaluate anatomic changes in the aortic root after different aortic root enlargement (ARE) techniques and assess the risk of coronary obstruction during future valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) procedures. Methods: In this retrospective analysis of 15 patients who underwent bioprosthetic aortic valve replacement with ARE using either the Konno or Y-incision technique, preoperative and postoperative computed tomography CT scans were reviewed to measure annular diameter, left ventricular outflow tract (LVOT), sinus of Valsalva (SOV), sinotubular junction, and coronary ostia locations. The risk of coronary obstruction was evaluated using virtual transcatheter heart valve-to-coronary ostium distance (VTC) and transcatheter heart valve-to-aorta distance (VTA). Results: Both groups showed significant increases in annulus and SOV sizes; however, only the Konno group exhibited a significant increase in LVOT size. The distance from the valve center to the coronary ostia was significantly greater in the Konno group compared to the Y-incision group (+4.2 ± 3.5 mm for the left/right coronary artery in the Konno group vs +2.4 ± 0.6 mm in the Y-incision group). The Konno group demonstrated greater VTC and VTA, with all cases achieving VTC ≥4 mm and VTA ≥2 mm. In the Y-incision group, 33.0% had VTC <4 mm and 17.0% had VTA <2 mm. Conclusions: The Konno procedure significantly increased LVOT size and access space to the coronary ostia, reducing the risk of coronary obstruction during future ViV-TAVR. These findings suggest that the Konno procedure may provide more favorable conditions compared to the Y-incision in such cases.http://www.sciencedirect.com/science/article/pii/S2666250725000677surgical aortic valve replacementaortic root enlargementtranscatheter aortic valve implantationvalve-in-valve |
| spellingShingle | Jiyoung Lee, MD, PhD Hiroshi Nakanaga, MD Nobuo Tomizawa, MD, PhD Yui Okada-Nozaki, MD, PhD Yuko Okano-Kawaguchi, MD, PhD Shinichiro Fujimoto, MD, PhD Minoru Tabata, MD, PhD Comparative analysis of anatomic changes and feasibility of valve-in-valve transcatheter aortic valve replacement between Konno and Y-incision aortic root enlargementCentral MessagePerspective JTCVS Techniques surgical aortic valve replacement aortic root enlargement transcatheter aortic valve implantation valve-in-valve |
| title | Comparative analysis of anatomic changes and feasibility of valve-in-valve transcatheter aortic valve replacement between Konno and Y-incision aortic root enlargementCentral MessagePerspective |
| title_full | Comparative analysis of anatomic changes and feasibility of valve-in-valve transcatheter aortic valve replacement between Konno and Y-incision aortic root enlargementCentral MessagePerspective |
| title_fullStr | Comparative analysis of anatomic changes and feasibility of valve-in-valve transcatheter aortic valve replacement between Konno and Y-incision aortic root enlargementCentral MessagePerspective |
| title_full_unstemmed | Comparative analysis of anatomic changes and feasibility of valve-in-valve transcatheter aortic valve replacement between Konno and Y-incision aortic root enlargementCentral MessagePerspective |
| title_short | Comparative analysis of anatomic changes and feasibility of valve-in-valve transcatheter aortic valve replacement between Konno and Y-incision aortic root enlargementCentral MessagePerspective |
| title_sort | comparative analysis of anatomic changes and feasibility of valve in valve transcatheter aortic valve replacement between konno and y incision aortic root enlargementcentral messageperspective |
| topic | surgical aortic valve replacement aortic root enlargement transcatheter aortic valve implantation valve-in-valve |
| url | http://www.sciencedirect.com/science/article/pii/S2666250725000677 |
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