Image‐Derived Modeling to Assess Coronary Proximity in Patients Undergoing Transcatheter Pulmonary Valve Replacement With Self‐Expanding Valves

• DOI: 10.1002/ccd.31469
• Publication Date: 2025-03-12T02:11:37Z
• Authors: Yuval Barak‐Corren; Vladislav Obsekov; Mudit Gupta; Christian Herz; Silvani Amin; Andras Lasso; Michael L. O'Byrne; Matthew J. Gillespie; Matthew A. Jolley

ABSTRACTBackgroundThe potential for coronary artery compression (CC) during transcatheter pulmonary valve replacement (TPVR) using self‐expanding valves (SEV) is not fully understood, yet anecdotal reports suggest that this risk exists.Aims and MethodsWe performed a retrospective cohort study of patients evaluated for SEV‐TPVR to evaluate the relationship between the right ventricular outflow tract (RVOT) and coronary arteries (CA). CT‐derived segmentations of the RVOT and CA were created using machine learning. A 2D map of the distance between the RVOT surface and CA, in systole and diastole, was created. In the subset of patients with post‐procedural CTA, the distance before and after TPVR was measured.ResultsForty‐two individuals underwent screening for SEV‐TPVR, of which 83% (n = 35) had SEV implanted (Harmony = 24; Alterra = 11). Median age was 22.9 years (range 12−60) and 76% had tetralogy of Fallot (TOF). There was no significant change in the distance between the RVOT and LCA between diastole and systole (p = 0.31), yet the RVOT area nearest to the LCA displaced proximally by 11 mm (IQR: 5.6−19.9) in systole. In 8 patients with pre‐ and post‐TPVR CTA, no statistically significant differences were observed in the RVOT‐to‐LCA relation after intervention. The distance to the LCA was smaller in pulmonary stenosis/atresia patients than those with TOF (median distance 1.2 and 2.1 mm, respectively; p = 0.185).ConclusionThe RVOT area in closest proximity to LCA is dynamic and should be considered when planning TPVR. Special attention should be given to patients with a diagnosis of pulmonary stenosis/atresia.