Bicuspid aortic valve sizing for transcatheter aortic valve implantation: Development and validation of an algorithm based on multi-slice computed tomography

Petronio, Anna Sonia; Angelillis, Marco; Backer, Ole De; Giannini, Cristina; Costa, Giulia; Fiorina, Claudia; Castriota, Fausto; Bedogni, Francesco; Laborde, Jean Claude; Søndergaard, Lars

doi:10.1016/j.jcct.2020.01.007

Cited by 38 publications

(25 citation statements)

References 24 publications

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“…Undersizing prosthesis were chosen based on LIRA method, known as Level of Implantation at the Raphe method, achieved 100% device success in 20 raphe-type BAV patients. In another CASPER study (Calcium Algorithm Sizing for bicusPid Evaluation with Raphe), 70% of prosthesis were undersized according to a new algorithm and no cases of moderate or severe PVL were found ( 9 ). Now the authors are expanding the indication of CASPER algorithm in type 0 patients (NCT04817735).…”

Section: Discussionmentioning

confidence: 99%

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The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study

Guo

Zhou

Dang

et al. 2021

Front. Cardiovasc. Med.

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Objective: To evaluate the predictors of new-onset conduction disturbances in bicuspid aortic valve patients using self-expanding valve and identify modifiable technical factors.Background: New-onset conduction disturbances (NOCDs), including complete left bundle branch block and high-grade atrioventricular block, remain the most common complication after transcatheter aortic valve replacement (TAVR).Methods: A total of 209 consecutive bicuspid patients who underwent self-expanding TAVR in 5 centers in China were enrolled from February 2016 to September 2020. The optimal cut-offs in this study were generated from receiver operator characteristic curve analyses. The infra-annular and coronal membranous septum (MS) length was measured in preoperative computed tomography. MSID was calculated by subtracting implantation depth measure on postoperative computed tomography from infra-annular MS or coronal MS length.Results: Forty-two (20.1%) patients developed complete left bundle branch block and 21 (10.0%) patients developed high-grade atrioventricular block after TAVR, while 61 (29.2%) patients developed NOCDs. Coronal MS <4.9 mm (OR: 3.08, 95% CI: 1.63–5.82, p = 0.001) or infra-annular MS <3.7 mm (OR: 2.18, 95% CI: 1.04–4.56, p = 0.038) and left ventricular outflow tract perimeter <66.8 mm (OR: 4.95 95% CI: 1.59–15.45, p = 0.006) were powerful predictors of NOCDs. The multivariate model including age >73 years (OR: 2.26, 95% CI: 1.17–4.36, p = 0.015), Δcoronal MSID <1.8 mm (OR: 7.87, 95% CI: 2.84–21.77, p < 0.001) and prosthesis oversizing ratio on left ventricular outflow tract >3.2% (OR: 3.42, 95% CI: 1.74–6.72, p < 0.001) showed best predictive value of NOCDs, with c-statistic = 0.768 (95% CI: 0.699–0.837, p < 0.001). The incidence of NOCDs was much lower (7.5 vs. 55.2%, p < 0.001) in patients without Δcoronal MSID <1.8 mm and prosthesis oversizing ratio on left ventricular outflow tract >3.2% compared with patients who had these two risk factors.Conclusion: The risk of NOCDs in bicuspid aortic stenosis patients could be evaluated based on MS length and prosthesis oversizing ratio. Implantation depth guided by MS length and reducing the oversizing ratio might be a feasible strategy for heavily calcified bicuspid patients with short MS.

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Section: Discussionmentioning

confidence: 99%

“…Several supra-annular sizing methods have been raised to select a smaller prosthesis with few paravalvular leakage and high device success (8)(9)(10), which might theoretically lower the incidence of conduction disturbances. Consequently, we performed this study to evaluate predictors of NOCDs in BAV patients using self-expanding valve.…”

Section: Introductionmentioning

confidence: 99%

The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study

Guo

Zhou

Dang

et al. 2021

Front. Cardiovasc. Med.

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“…In conclusion, the authors suggested that the SA method in BAV should no longer be pursued. Petronio et al proposed another method called CASPER: Calcium Algorithm Sizing for bicusPid Evaluation with Raphe [ 28 ]. This approach is focused on 3 features: 1) calcium score, 2) raphe length with respect to annulus diameter, 3) calcium localization in relation to raphe.…”

Section: Sizingmentioning

confidence: 99%

Ten-year experience with transcatheter aortic valve implantation in bicuspid aortic valve: lessons learned and future perspectives

Walczewski

Huczek

Rymuza

et al. 2021

pwki

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Bicuspid aortic valve (BAV) stenosis has traditionally been perceived as a contraindication to transcatheter aortic valve implantation (TAVI) due to its specific anatomical characteristics including extensive calcifications, high leaflet coaptation and frequently encountered aortic root dilation, which may result in worse procedural outcomes and higher risk of complications. Hence, BAV patients were not included in previous clinical trials. In the recent years, improved pre-procedural imaging and technological advances have gradually enabled expansion of TAVI to patients with complex anatomy, including those with BAV. Moreover, indications for TAVI are expanding to a younger group of patients with fewer comorbidities, and BAV is more prevalent in this population. Contemporary multicenter registry-based studies indicate that patients undergoing TAVI for BAV have similar outcomes as those with tricuspid aortic valve stenosis. In this article, we provide a thorough overview of the available clinical data regarding the outcomes of TAVI in BAV, from the perspective of an experienced TAVI center with over 150 TAVIs in this group of patients, performed in our institution since the year 2009. We present anatomical and clinical classifications of BAV, differences in outcomes in patients with bicuspid and tricuspid valves, as well as important topics regarding choice of an adequate valve and valve size.

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“…A more recent publication proposed a new algorithm for sizing stenotic BAV under evaluation for TAVR. 10 It is based on three variables: the ratio between raphe length and annulus diameter; calcium burden; calcium distribution in relation to the raphe. This study has several methodological limitations but some interesting points, such as the use of raphe length and calcium burden for a more proper evaluation of THV sizing.…”

Section: Anatomymentioning

confidence: 99%

Transcatheter aortic valve replacement for bicuspid valves – from anatomy all the way to the treatment

Esteves¹,

Tchétché²

2020

J Transcat Intervent

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The transcatheter aortic valve implantation has revolutionized the treatment of symptomatic severe aortic stenosis in patients likely to have complications in the conventional surgery, particularly the elderly. However, almost all randomized clinical trials that assessed this therapeutical modality excluded patients with bicuspid aortic valve, due to the anatomic and technical particularities related to this condition. Enhanced understanding about the aspects inherent to percutaneous treatment of bicuspid aortic valve stenosis is crucial to obtain better clinical and hemodynamic results.

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Bicuspid aortic valve sizing for transcatheter aortic valve implantation: Development and validation of an algorithm based on multi-slice computed tomography

Cited by 38 publications

References 24 publications

The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study

The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study

Ten-year experience with transcatheter aortic valve implantation in bicuspid aortic valve: lessons learned and future perspectives

Transcatheter aortic valve replacement for bicuspid valves – from anatomy all the way to the treatment

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