Abstract 13238: Aortic Annulus in Severe Bicuspid Aortic Valve Stenosis: Implications for Transcatheter Aortic Valve Therapies
Background: Transcatheter aortic valve replacement (TAVR) is used to treat severe aortic stenosis (AS) but contraindicated in bicuspid aortic valves (BCV). We sought to characterize the aortic annulus in BCV and tricuspid aortic valves (TCV).
Methods: We identified patients with severe AS who underwent multi-detector computed tomographic (MDCT) imaging prior to surgical aortic valve replacement (SAVR, n=200) for BCV and TAVR (n=200) for TCV from 2006-2013. Annulus measurements of the basal ring (short- and long-axis, area-derived diameter), coronary ostia height, sinus area (SA), sino-tubular junction area (STJ), calcification and eccentricity index (EI, 1-short axis/long axis) were made.
Results: Patients undergoing TAVR were older (58.7 years versus 78.8 years, p=0.02) with a high prevalence of atherosclerosis (70% vs. 20%, p=0.04) than those undergoing SAVR. There were no differences in the severity of AS or aortic insufficiency in both groups (p=0.8). Aortic annulus area were similar (49.2 ± 17.2 mm2 vs. 46.1 ± 20.5 mm2, p=0.15) with less eccentricity (0.20 ± 0.14 mm vs. 0.22 ± 0.16 mm, p=0.01) and more eccentric calcification (p=0.01) in BCV vs. TCV. Aortic SA (35.6 ± 8.7 mm2 vs. 33.7 ± 9.5 mm2, p=0.003), STJ (30.1 ± 10.0 mm2 vs. 27.1 ± 7.9 mm2, p=0.001) and coronary ostia height (15.8 ± 7.9 mm vs 14.1 ± 6.3 mm, p=0.001) were higher in BCV vs. TCV.
Conclusion: Bicuspid aortic valves have a similar annulus size with less eccentricity with more eccentric calcification than TAV undergoing TAVR. These observations suggest that although size and shape of the annulus of BAV is appropriate for TAVR, more eccentric calcification could have an impact on paravalvular leak.
- © 2013 by American Heart Association, Inc.