Development of an Algorithm to Optimize Percutaneous Coronary Intervention Through Supra-Annular Self-Expandable Transcatheter Heart Valve

Two elderly patients were scheduled for percutaneous coronary intervention (PCI) after implantation of a supra-annular self-expandable transcatheter heart valve (SE-THV). In both cases, computed tomography) identified that the commissure post of the SE-THV rests in front of the target coronary arteries. Screening using a virtual reality system enabled the fusion of computed tomography images and suggested possible target frames for the SE-THV. We also created a novel Evo-MAP that judged the appropriateness of suggested frame considering the position of SE-THV leaflets and skirt. The preprocedural virtual reality and Evo-MAP assessments provided an optimal approach route, guiding catheter, and target frame for the SE-THV during PCI. Finally, the 2 cases described successful PCI through an SE-THV that was completely misaligned toward the coronary ostium. Clinical demands require overcoming the difficulties of PCI using SE-THV. Supported by this new concept, the difficulty level of PCI after SE-THV can be minimized.