Aortic annulus and root characteristics in severe aortic stenosis due to bicuspid aortic valve and tricuspid aortic valves: Implications for transcatheter aortic valve therapies

Femi Philip, Nadeen Faza, Paul Schoenhagen, Milind Y. Desai, E. Murat Tuzcu, Lars G. Svensson, Samir R. Kapadia

Research output: Contribution to journalArticle

49 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)E88-E98
JournalCatheterization and Cardiovascular Interventions
Volume86
Issue number2
DOIs
StatePublished - Aug 1 2015

Keywords

  • aortic valve disease
  • percutaneous intervention
  • percutaneous valve therapy
  • structural heart disease intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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