Rotation characteristics and neo‐commissural alignment of transcatheter heart valve in type‐0 bicuspid aortic valve

Abstract

Aims This study sought to characterize the rotation of the transcatheter heart valve (THV) and evaluate the neo‐commissures overlap with coronary arteries in type‐0 bicuspid aortic valve (BAV). Methods and Results This was a single‐center, 10‐patient, retrospective observational cohort. Pre‐TAVI computed tomography and procedural fluoroscopy were analyzed. Coplanar fluoroscopic views were coregistered to pre‐TAVI computed tomography to characterize THV rotation and determine coronary overlap. The incidence of severe coronary artery overlap with one coronary artery was 90%. According to our prediction line, type‐0 BAV has predicted a higher incidence of overlap with one coronary artery, but lower incidence with both coronary arteries compared to the tricuspid aortic valve (TAV). The rotational angles in two different phases were 3.8 ± 3.2° versus 11.8 ± 8.0° (p = .01) in patients with mixed cusp fusion. Commissural angles in final and initial deployment were 9.6 ± 6.6 versus 18.1 ± 11.0° (p = .021). Applying hypothetic “commissure‐middle view” in 0°, ±5°, and ±10°, the incidence of overlap with one coronary artery are 20%, 40%, and 90% separately. Conclusions The THV rotation existed and was activated in the last 1/3 deploying phase. With the observed tendency of “automatic commissural alignment,” applying the “commissure‐middle” view in type‐0 BAV may optimize valve alignment and avoid coronary artery overlap.

Neo-Commissural Alignment by Withdrawing and Readvancing the Delivery System during Transcatheter Aortic Valve Replacement with Self-Expanding Prosthesis

“…If the centre marker is closed to or overlapped with the left one on the fluoroscopic image, we will withdraw the delivery system to the descending aorta and rotate the delivery system 180°, then readvance the THV to the aortic annulus. The neo-commissural alignment or mild commissural misalignment was obtained in all five cases present in our study, although the THV rotated in the deploying phase by some degrees [ 2 ].…”

“…If percutaneous coronary intervention is required after transcatheter aortic valve replacement (TAVR), coronary access will be more challenging when transcatheter heart valves (THVs) commissural posts face a coronary orifice, particularly with self-expanding valves [ 1 ]. Venus-A plus THV (Venus Medtech Inc, Hangzhou, China) has three inflow markers that are in alignment with the nadirs of THV sinuses ( Figure 1 ) [ 2 , 3 ]. Our previous study showed that neo-commissural alignment could be evaluated by observing the three markers of the Venus-A plus THV (3).…”

Commissural alignment: In the quest of the perfect transcatheter heart valve orientation

“…5,7,8 Recently, Bieliauskas et al 9 Commissural alignment of THV in patients with bicuspid aortic valve (BAV) is even more challenging given the complex aortic root anatomy frequently found in these cases. Therefore, Chen et al 10 are to be congratulated to have come up with a specific commissure-middle view technique to optimize commissural alignment in THV in type-0 BAV. This was a retrospective observational study of patients undergoing TAVR with the selfexpandable Venus A-Valve (Venus MedTech).…”