Influence of Cardiac Phase on Valve-to-Coronary Ostia Distance in Valve-in-Valve Transcatheter Aortic Valve Replacement

Background: No consensus exists on which cardiac phase to use for virtual valve-to-coronary ostium (VTC) distance measurement to predict risk of coronary obstruction in valve-in-valve (ViV). Our study aims to investigate whether cardiac phase influences VTC measurements in ViV for failing stented surgical heart valves (SHV).Methods: All adult patients with stented SHV referred for a pre-planning CT for ViV between 2020 and 2025 were retrospectively eligible. For each patient, VTC was measured for two transcatheter heart valve options at both the right and left coronary ostia. VTC measurements were compared between systole, diastole, and phase with best image quality (best phase). Prevalence of changes in coronary obstruction risk (based on 4 mm cut-off) depending on the phase was collected. Inter- and intraobserver reliability was evaluated.Findings: A total of 398 coronary arteries derived from 116 included patients (69 male, 71 ± 13 years) were evaluated. Best phase was more often diastolic. Mean VTCs were different between systole and diastole (p<0.001), and systole and best phase (p=0.004), but not between diastole and best phase (p=0.51) (systole 4.8 (3.1-6.5) mm vs. diastole 4.6 (3.1-6.2) mm vs. best phase 3.9 (2.5-6.2) mm). Measurements were slightly higher in systole compared to diastole (mean bias +0.24 mm,[95% CI: 0.16,0.32]; p<0.001), but similar between diastole and best phase (p=0.45). Risk of coronary obstruction changed between systole and diastole in 41 coronary arteries (10%). Intra- and interobserver reliability was good-to-excellent. Interpretation: VTC measurements are different and slightly higher in systole compared to diastole, which may influence the coronary obstruction risk classification.