Characterization of aortic root geometry in transcatheter aortic valve replacement patients

Abstract

Purpose The study aimed to characterize the geometry of the aortic root pre‐ and post‐transcatheter aortic valve replacement (TAVR) and investigate differences in pre‐ and post‐TAVR anatomy. Background A greater understanding of how aortic root geometry changes after TAVR is needed to facilitate further investigation into the hemodynamic profiles of the post‐TAVR aortic root. Methods Anatomical measurements were conducted on de‐identified, retrospective post‐TAVR 4DCT scans of 109 patients with aortic stenosis obtained from the RESOLVE study. The diameter of the aortic root was measured at the level of the annulus, left ventricular outflow tract (LVOT), sinus of Valsalva, sinotubular junction (STJ) and ascending aorta. The heights of the STJ and coronary arteries were also measured. Results All aortic root dimensions were normally distributed across the cohort and changed significantly between pre‐ and post‐TAVR conditions (P < 0.01). Post‐TAVR dimensions changed significantly from peak systole to end diastole (P < 0.01). Regression models were obtained for all aortic root dimensions in terms of annulus diameter with excellent coefficient of determination (R2 > 0.95, P < 0.001). Conclusions There are significant differences between pre‐ and post‐TAVR as well as peak systolic and end diastolic aortic root anatomy. Appropriate anatomical dimensions should be selected for benchtop testing as the geometry varies greatly throughout the cardiac cycle.

Bioengineering Case Study to Evaluate Complications of Adverse Anatomy of Aortic Root in Transcatheter Aortic Valve Replacement: Combining Biomechanical Modelling with CT Imaging

“…These changes involved the diameter of the aortic anulus and the height of the coronary ostia, all significantly reduced in comparison to pre-TAVR. These findings are only in partial agreement with the ones by Madukauwa-David et al [14], who performed a retrospective post-TAVR analysis of 4-D CT from 109 patients successfully implanted with Sapien 3 and CoreValve at a mean follow-up of 6.1 ± 7.0 months [15]. These authors did not find differences in aortic diameter post TAVR, while left coronary artery height decreased by 22% and right coronary artery height increased by 7.3% [14].…”

“…These findings are only in partial agreement with the ones by Madukauwa-David et al [14], who performed a retrospective post-TAVR analysis of 4-D CT from 109 patients successfully implanted with Sapien 3 and CoreValve at a mean follow-up of 6.1 ± 7.0 months [15]. These authors did not find differences in aortic diameter post TAVR, while left coronary artery height decreased by 22% and right coronary artery height increased by 7.3% [14]. It is difficult to explain the reasons underlying these differences; however, it is possible to speculate that several anatomical and technical factors might have affected the implantation in our patient, which indeed was readmitted with a severe complication after an apparently successful TAVR.…”

“…It is difficult to explain the reasons underlying these differences; however, it is possible to speculate that several anatomical and technical factors might have affected the implantation in our patient, which indeed was readmitted with a severe complication after an apparently successful TAVR. The CT scans analysed by Madukauwa-David et al [14] belonged to patients implanted with no periprocedural problems and no further mid-term complications. Additionally, it should be considered that the localization, characteristics and distribution of the calcifications were not parameters included in their analysis.…”

Transcatheter aortic valve deployment influences neo‐sinus thrombosis risk: An in vitro flow study

“…Key aortic root anatomical dimensions of the patient are given in Table S1. The aortic root anatomy used was representative of the TAVR patient population as described in our previous work . The aortic root flow model was a transparent 3D print (Accura ClearVue, 3D Systems, Rock Hill, South Carolina).…”

Biomechanics of Transcatheter Aortic Valve Implant

“…These findings can help select optimal THV device sizes that are appropriate to anatomical dimensions, as geometry varies greatly during the cardiac cycle [99].…”