Using a unique aortic root anatomical classification may help determine the feasibility of deploying a second S3 transcatheter aortic valve (TAV) within a previously implanted S3 TAV (TAV-in-TAV), according to a study published March 4 in JACC: Cardiovascular Interventions, which will be presented during ACC.19 in New Orleans, LA.

Gilbert H.L. Tang, MD, MSc, MBA, FACC, et al., evaluated post-deployment aortography in 484 S3 TAVR patients to determine the risk of left main coronary obstruction with TAV-in-TAV.

The authors defined three aortic root types based on sinotubular junction (STJ) diameter and sinus height (SH) relative to the transcatheter valve diameter (TVD) and height (See Table 1 below).

They determined that TAV-in-TAV was not feasible within an S3 valve if the valve-to-sinus distance and/or valve-to-sinus height was 2 mm or less given the possibility of coronary obstruction.

There was no difference between the feasible and not feasible groups in sinus height, but the not feasible group had significantly smaller minimum, maximum and mean STJ diameters in Type 2 root for 29S3 valves, and in Type 3 root for 23S3, 26S3 and 29S3 valves. Overall, TAV-in-TAV was not feasible in 20 percent of patients assessed.

The authors suggest that aortic root type, STJ and SH be routinely evaluated to determine valve selection and positioning for TAV-in-TAV, something that becomes more important as younger patients undergo TAVR.

Table 1: Aortic Root Types
		TAV-in-TAV Feasibility
Type 1	STJ>TVD and SH>TVH	100 percent (n= 311, 56.4 percent)
Type 2	STJ≤TVD and SH>TVH	63.5 percent (n=74, 13.4 percent)
Type 3	STJ≥TVD but SH<TVH	45.2 percent (n=166, 30.1 percent)
*All P<0.001 STJ, sinotubular junction; TVD, transcatheter valve diameter; SH, sinus height; TVH, transcatheter heart valve

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Aortic Surgery, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: ACC19, ACC Scientific Session Newspaper, Aortography, Transcatheter Aortic Valve Replacement, Aortic Valve, Aorta, Diabetes Mellitus, Type 2

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