Development of a Single Endovascular Device for Aortic Valve Replacement and Ascending Aortic Repair

Background and aim of the study Transcatheter aortic valve implantation (TAVI) is contraindicated in the presence of an ascending aortic aneurysm. Our aim was to design a composite endovascular device enabling ascending aortic repair and TAVI. Methods From 2007 to 2013, among 1196 patients with severe aortic stenosis screened for TAVI, 79 nonbicuspid patients had ascending aortic diameter >45 mm. Proximal aortic geometry was assessed in those with computed tomography angiography. Results All together, 51 patients (35 males, aged 85 +/- 8 years; 19 TAVI, 10 open Wheat procedures, 22 managed conservatively) were included. The required annular diameter for implantation of currently available TAVI prostheses was met in 41% (21/51). Novel prosthetic valves appropriate for annular range up to 30 mm would extend device applicability to 78% (40/51). Proximal and distal diameters of the graft-covering portion ranging between 30 and 46 mm would enable 10% graft oversizing in all but six patients. In 88% (45/51) the required minimum 10 mm distance between aortic valve annulus and coronary artery ostia was found. Mean distance between left and right coronary artery ostia and sinotubular junction was 2.6 +/- 1.5 and 3.2 +/- 1.7 mm, respectively. Conclusions Novel composite endovascular valved grafts may extend the application of transcatheter techniques to patients denied TAVI due to a concomitant ascending aneurysm. The location of coronary arteries in relation to the sinotubular junction must be addressed in designing these composite valve grafts. doi: 10.1111/jocs.12348 (J Card Surg 2014;29:371-376)