TY - JOUR
T1 - Aortic annulus and root characteristics in severe aortic stenosis due to bicuspid aortic valve and tricuspid aortic valves
T2 - Implications for transcatheter aortic valve therapies
AU - Philip, Femi
AU - Faza, Nadine Nadar
AU - Schoenhagen, Paul
AU - Desai, Milind Y.
AU - Tuzcu, E. Murat
AU - Svensson, Lars G.
AU - Kapadia, Samir R.
N1 - Publisher Copyright:
© 2015 Wiley Periodicals, Inc.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background Patients with severe aortic stenosis due to BAV are excluded from transcatheter aortic valve replacement (TAVR) due to concern for asymmetric expansion and valve dysfunction. We sought to characterize the aortic root and annulus in bicuspid aortic valve (BAV) and tricuspid aortic valves (TAV). Methods and Results We identified patients with severe AS who underwent multi-detector computed tomographic (MDCT) imaging prior to surgical aortic valve replacement (SAVR, n-=-200) for BAV and TAVR (n-=-200) for TAV from 2010 to 2013. The presence of a BAV was confirmed on surgical and pathological review. Annulus measurements of the basal ring (short- and long-axis, area-derived diameter), coronary ostia height, sinus area (SA), sino-tubular junction area (STJ), calcification and eccentricity index (EI, 1-short axis/long axis) were made. Patients with TAV were older (78.8 years vs. 57.8 years, P-=-0.04) than those with BAV. The aortic annulus area (5.21-±-2.1 cm2 vs. 4.63-±-2.0 cm2, P-=-0.0001), sinus of Valsalva diameter (3.7-±-0.9 cm vs. 3.1-±-0.1 cm, P-=-0.001) and ascending aorta diameter (3.5-±-0.7 cm vs. 2.97-±-0.6 cm, P-=-0.001) were significantly larger with BAV. Bicuspid aortic annuli were significantly less elliptical (EI, 1.24-±-0.1 vs. 1.29-±-0.1, P-=-0.006) and more circular (39% vs. 4%, P-<-0.001) compared to the TAV annulus. There was more eccentric annular calcification in BAV vs. TAV (68% vs. 32%, P-<-0.001). The mean distance from the aortic annulus to the left main coronary ostium was less than the right coronary ostium. Less than 10% of the BAV annuli would not fit a currently available valved stents. Conclusion Bicuspid aortic valves have a larger annulus size, sinus of Valsalva and ascending aorta dimensions. In addition, the BAV aortic annuli appear circular and most will fit currently available commercial valved stents.
AB - Background Patients with severe aortic stenosis due to BAV are excluded from transcatheter aortic valve replacement (TAVR) due to concern for asymmetric expansion and valve dysfunction. We sought to characterize the aortic root and annulus in bicuspid aortic valve (BAV) and tricuspid aortic valves (TAV). Methods and Results We identified patients with severe AS who underwent multi-detector computed tomographic (MDCT) imaging prior to surgical aortic valve replacement (SAVR, n-=-200) for BAV and TAVR (n-=-200) for TAV from 2010 to 2013. The presence of a BAV was confirmed on surgical and pathological review. Annulus measurements of the basal ring (short- and long-axis, area-derived diameter), coronary ostia height, sinus area (SA), sino-tubular junction area (STJ), calcification and eccentricity index (EI, 1-short axis/long axis) were made. Patients with TAV were older (78.8 years vs. 57.8 years, P-=-0.04) than those with BAV. The aortic annulus area (5.21-±-2.1 cm2 vs. 4.63-±-2.0 cm2, P-=-0.0001), sinus of Valsalva diameter (3.7-±-0.9 cm vs. 3.1-±-0.1 cm, P-=-0.001) and ascending aorta diameter (3.5-±-0.7 cm vs. 2.97-±-0.6 cm, P-=-0.001) were significantly larger with BAV. Bicuspid aortic annuli were significantly less elliptical (EI, 1.24-±-0.1 vs. 1.29-±-0.1, P-=-0.006) and more circular (39% vs. 4%, P-<-0.001) compared to the TAV annulus. There was more eccentric annular calcification in BAV vs. TAV (68% vs. 32%, P-<-0.001). The mean distance from the aortic annulus to the left main coronary ostium was less than the right coronary ostium. Less than 10% of the BAV annuli would not fit a currently available valved stents. Conclusion Bicuspid aortic valves have a larger annulus size, sinus of Valsalva and ascending aorta dimensions. In addition, the BAV aortic annuli appear circular and most will fit currently available commercial valved stents.
KW - aortic valve disease
KW - percutaneous intervention
KW - percutaneous valve therapy
KW - structural heart disease intervention
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U2 - 10.1002/ccd.25948
DO - 10.1002/ccd.25948
M3 - Article
C2 - 25914355
AN - SCOPUS:84937522105
SN - 1522-1946
VL - 86
SP - E88-E98
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 2
ER -