Aortic root geometry in aortic stenosis patients (a SEAS substudy)

Abstract

AimsTo report aortic root geometry by echocardiography in a large population of healthy, asymptomatic aortic stenosis (AS) patients in relation to current vendor-specified requirements for transcatheter aortic valve implantation (TAVI). Methods and resultsBaseline data in 1481 patients with asymptomatic AS (mean age 67 years, 39% women) in the Simvastatin Ezetimibe in AS study were used. The inner aortic diameter was measured at four levels: annulus, sinus of Valsalva, sinotubular junction and supracoronary, and sinus height as the annulo-junctional distance. Analyses were based on vendor-specified requirements for the aortic root geometry for current available prostheses, CoreValve and Edwards-Sapien. The ratio of sinus of Valsalva height to sinus width was 1:2. In multivariate linear regression analysis, larger sinus of Valsalva height was associated with older age, larger sinus of Valsalva diameter, lower ejection fraction and smaller supracoronary diameter (multiple R 2 ¼ 0.19, P , 0.01). The required annulus diameter for implantation of CoreValve was met in 61.9%, and for the Edwards-Sapien prosthesis in 66.9%. Overall, annular dimension feasible for TAVI using any available prosthesis was found in 78.2% of patients and in 77.7% of patients also the required minimum sinus of Valsalva height was found. Comparing the group of patients who met TAVI requirements to those who did not, the latter included more women and patients with lower body height and weight and significantly smaller aortic root diameters (all P , 0.05). ConclusionAmong AS patients in the SEAS study, 27% of women and 19% of men did not have aortic root geometry fulfilling current requirements for TAVI.--

Left Ventricular Systolic Myocardial Function in Ankylosing Spondylitis

“…LV mass was indexed for height in the allometric power of 2.7 (height 2.7 ) . Aortic root diameter was measured as inner diameter in end‐diastole at the sinus of Valsalva . LV systolic function was estimated by ejection fraction using biplane Simpson's method.…”

Global left ventricular load in asymptomatic aortic stenosis: covariates and prognostic implication (the SEAS trial)

“…Global LV load was assessed as valvulo-arterial impedance (Zva) calculated by the method published in the paper by Briand et al taking into account the net mean aortic gradient and thus the phenomenon of pressure recovery: Zva = (Systolic arterial pressure + Mean net aortic gradient) / (Stroke volume/body surface area) [3]. The net mean gradient was calculated as the mean aortic gradient corrected for actual pressure recovery in the individual patient [25,26]. Pressure recovery (mm Hg) was calculated at the sinotubular junction level of the aorta as 4v 2 × 2AVA/Aa[1 – (AVA/Aa)], where v is the mean aortic jet velocity, AVA is calculated by the continuity equation and Aa is the aortic area [3].…”

The Influence of the Aortic Root Geometry on Flow Characteristics of a Prosthetic Heart Valve

“…These pathological changes in extreme scenarios are often associated with patients morbidity due to aortic dissection, aortic incompetence caused by a dilated, aneurysmal aortic root, and severe aortic valve stenosis [27][28][29][30], In addition, deformation of the aortic root after valve replacement or structural dysfunction of the recently replaced bioprosthetic heart valve due to premature calcification associated with pure stenosis due to cusps stiffening is not uncommon [31,32]. These pathological changes in extreme scenarios are often associated with patients morbidity due to aortic dissection, aortic incompetence caused by a dilated, aneurysmal aortic root, and severe aortic valve stenosis [27][28][29][30], In addition, deformation of the aortic root after valve replacement or structural dysfunction of the recently replaced bioprosthetic heart valve due to premature calcification associated with pure stenosis due to cusps stiffening is not uncommon [31,32].…”

“…First, the accurate measure ment of the aortic root geometry in clinical settings is required for evaluation of the patients with aortic valve or aortic root disease and determining whether the proposed device can be safely and successfully implanted, which is primarily related to the newly emerged transcatheter aortic valve implantation (TAVI) [25,27,33]. First, the accurate measure ment of the aortic root geometry in clinical settings is required for evaluation of the patients with aortic valve or aortic root disease and determining whether the proposed device can be safely and successfully implanted, which is primarily related to the newly emerged transcatheter aortic valve implantation (TAVI) [25,27,33].…”

“…Nowadays, there are several highly sophisticated methodologies that are capable of accurate assessment of the major dimensions of the aortic root [25,27,34]. The projectional radiography or angiography is a technique that employs a special dye in order to visualize the blood flow in arteries as well as the dimensions of the arteries.…”