The expansion of TAVI will involve 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.We retrospectively analysed 117 CTs acquired after TAVI
procedures with high stent prostheses in three high-volume centres 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 <30 mm in 8/117 (6.8%) patients
and <20 mm in none. The mean distance between the sinotubular junction and the first
free site for aortotomy was 22±7 mm (>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.Aortic cross-clamp appears not to be
an issue when cardiac surgery is needed after TAVI; however, 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.
Visual summary. Proper aortic cross-clamp and careful higher aortotomy after TAVI.
