Anatomical spatial distribution of the bilateral coronary ostia and aortic valve commissures relative to the aortic arch

BACKGROUND: Previous studies have shown the importance of achieving commissural alignment during transcatheter aortic valve replacement (TAVR). However, the anatomical spatial distribution of the bilateral coronary ostia and aortic valve commissures relative to the aortic arch is still unknown. This study aimed to evaluate this anatomical relationship. METHODS: A retrospective cross-sectional study was designed. Patients who underwent pre-procedural electrocardiographically gated computed tomography (CT) angiography with a second-generation dual-source CT scanner were enrolled in this study. Three-dimensional reconstruction was performed, and the inner curve (IC) of the aortic arch was defined. The angles between the coronary arteries or aortic valve commissures and the IC were measured. RESULTS: Ultimately, 80 patients were included in the analysis. The angle from the IC to the left main (LM) was 48.0°±17.5°, and the angle from the IC to the right coronary artery (RCA) was 172.6°±15.2°. The median angle from the IC to the non-coronary cusp (NCC)/left coronary cusp (LCC) commissure was −12.8° with an interquartile range (IQR) of −21.5° to −2.2°, the angle from the IC to the LCC/right coronary cusp (RCC) commissure was 102.4°±15.1°, and the angle from the IC to the RCC/NCC commissure was 219.9°±13.9°. CONCLUSIONS: This study found a fixed angular relationship between the coronary ostia or aortic valve commissures and the IC of the aortic arch. This relationship could help to establish an individualized implantation method that would enable commissural and coronary alignment to be achieved in TAVR.