Supra-annular sizing of transcatheter aortic valve prostheses in raphe-type bicuspid aortic valve disease: the LIRA method

Iannopollo, Gianmarco; Romano, Vittorio; Buzzatti, Nicola; Ancona, Marco; Ferri, Luca; Russo, Filippo; Bellini, Barbara; Granada, Juan F.; Chieffo, Alaide; Montorfano, Matteo

doi:10.1016/j.ijcard.2020.05.076

Cited by 33 publications

(15 citation statements)

References 26 publications

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“…In our single center analysis, the TAVR outcome in bicuspid patients was feasible with high device success rate of 84.5% and good performance even with first generation devices. Several recent studies have also suggested the safety and effectiveness of prosthesis undersizing based on supra-annular sizing methods ( 8 , 10 , 38 , 39 ). LIRA method, known as Level of Implantation at the RAphe (LIRA) method, was applicated in 20 raphe-type BAV patients.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, over the past few years, undersizing of prosthesis especially in highly calcified bicuspid patients has been a topic. Several supra-annular sizing methods have been raised to select a smaller prosthesis with few paravalvular leakage and high device success ( 8 – 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%

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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%

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 the group of bicuspid valve with raphe, perimeter-derived diameter showed the strongest correlation with TAD. There are several recent studies dealing with the annular measurement on CT 23 , 24 . Boccalini et al demonstrated that the annulus in bicuspid aortic valve undergoes significant change in shape during cardiac cycle similar to that encountered in tricuspid valves but with overall larger dimension 23 .…”

Section: Discussionmentioning

confidence: 99%

Aortic annulus sizing in bicuspid and tricuspid aortic valves using CT in patients with surgical aortic valve replacement

Choe

Koo

Kang

et al. 2021

Sci Rep

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The purpose of this study was to evaluate whether bicuspid anatomy affects the discrepancy between CT-derived annular size and intraoperative size. We retrospectively analyzed annular measurements in 667 patients who underwent surgical aortic valve replacement (AVR). Preoperative CT measurements of the aortic annulus were compared to surgically implanted valve sizes. To evaluate whether the bicuspid valve affects the differences between CT annulus diameter and surgical AVR size, patients with diameter larger by > 10% (CT-Lg group) on CT, compared to surgical AVR size, were compared with those having size difference < 10% (CT-Sim group). Propensity score matching yielded 183 matched patients from each group. Bicuspid aortic valve annulus parameters significantly correlated with surgical aortic valve size (r = 0.52–0.71; for all, p < 0.01). The most representative measurements corresponded to surgical aortic valve size were area-derived diameters in tricuspid aortic valve (r = 0.69, p < 0.001) and bicuspid without raphe (r = 0.71, p < 0.001), and perimeter-derived diameter in bicuspid with raphe (r = 0.63, p < 0.001). After propensity score matching, native valve type was not different between CT-Sim and CT-Lg groups. In multivariable analysis, the difference between CT-derived diameter and surgical AVR size was affected by the operator factor and types of prosthesis. Bicuspid aortic annulus diameters measured on CT showed a significant correlation with surgical aortic valve size. The difference between CT-derived diameter and surgical AVR size is affected by operator factor and the types of prosthesis but not affected by the bicuspid valve.

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“…The method described by Iannopollo et al (40) aims to recognize the plane where valve anchoring is assumed. For BAV type 1, the prosthesis should anchor at the level of the raphe.…”

Section: Lira Methodsmentioning

confidence: 99%

Bicuspid Valve Sizing for Transcatheter Aortic Valve Implantation: The Missing Link

Costa

Angelillis

Petronio

2022

Front. Cardiovasc. Med.

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Transcatheter aortic valve implantation (TAVI) is a well-recognized and established therapy for severe aortic stenosis, with expanding indications toward younger patients with low surgical risk profile. As bicuspid aortic valve (BAV) affects ~1–2% of the population, it may be speculated that an increasing number of patients with degenerated BAV may eventually need TAVI during the course of the disease. On the other hand, BAV represents a challenge due to its peculiar anatomical features and the lack of consensus on the optimal sizing strategy. The aim of this paper is to review the peculiar aspects of BAV and to discuss and compare the currently available sizing methods. Special attention is given to the role of pre-procedural imaging, mostly with multislice computed tomography, and to the aspects that operators should evaluate in order to ensure an optimal procedural planning and avoid procedural-related complications.

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Supra-annular sizing of transcatheter aortic valve prostheses in raphe-type bicuspid aortic valve disease: the LIRA method

Cited by 33 publications

References 26 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

Aortic annulus sizing in bicuspid and tricuspid aortic valves using CT in patients with surgical aortic valve replacement

Bicuspid Valve Sizing for Transcatheter Aortic Valve Implantation: The Missing Link

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