Aims: 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.

Methods and results: 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.

Conclusions: 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.

目的： TAVI 的扩展将涉及 THV 植入后急诊或晚期心脏手术频率的增加。本研究旨在通过 TAVI 后 CT 扫描评估来研究 TAVI 后手术交叉钳夹和主动脉切开术的解剖学可行性。

方法和结果：我们回顾性分析了 2008 年 10 月至 2017 年 5 月期间在三个高容量中心进行的 TAVI 手术后获得的 117 例 CT。观察到的无名动脉与经导管心脏瓣膜顶部之间的平均距离为 45±11毫米，8/117 (6.8%) 名患者 <30 毫米，没有患者 <20 毫米。窦管交界处与主动脉切开术第一个游离部位之间的平均距离为 22±7 mm（78/117 [66.7%] 病例中 >20 mm）。共有 56/117 (47.9%) 名患者表现出主动脉前壁与瓣膜支架前部之间的完全连续接触。

结论：当 TAVI 后需要心脏手术时，主动脉钳闭似乎不是问题；然而，可能需要小心且可能更高的主动脉切开术。应在 TAVI 后计划的心脏手术之前进行 CT，以确定主动脉夹闭和主动脉切开术的安全定位。

视觉总结。TAVI 后适当的主动脉交叉钳夹和仔细的高位主动脉切开术。