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Region Hovedstaden - en del af Københavns Universitetshospital
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Bicuspid Aortic Valve Anatomy and Relationship With Devices: The BAVARD Multicenter Registry

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  • Didier Tchetche
  • Chiara de Biase
  • Lennart van Gils
  • Radoslaw Parma
  • Andrzej Ochala
  • Thierry Lefevre
  • Thomas Hovasse
  • Ole De Backer
  • Lars Sondergaard
  • Sabine Bleiziffer
  • Rudiger Lange
  • Ran Kornowski
  • Uri Landes
  • Bjarne Linde Norgaard
  • Luigi Biasco
  • Raphaël Philippart
  • Javier Molina-Martin de Nicolas
  • Darren Mylotte
  • Caroline Lemee
  • Nicolas Dumonteil
  • Nicolas M Van Mieghem
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BACKGROUND: Sizing for transcatheter aortic valve implantation in bicuspid aortic valves (BAV) remains controversial.

METHODS AND RESULTS: The aim of the BAVARD (Bicuspid Aortic Valve Anatomy and Relationship With Devices) retrospective registry is to capture the sizing ratios used for transcatheter aortic valve implantation in BAV and analyze the second-generation prostheses geometry postimplantation. About 101 patients with BAV along with available pre- and post-transcatheter aortic valve implantation multidetector computed tomography were compared with 88 tricuspid aortic valves (TAV) patients. Preprocedural multidetector computed tomography diagnosed type 0 and type 1 BAV in, respectively, 12.9% and 86.1 % of BAV. At baseline, the ellipticity index was similar between BAV and TAV patients: 1.2±0.1 versus 1.2±0.1, P=0.09. The mean annular oversizing was, respectively, 1.14±0.04 and 1.04±0.04, P<0.001, in TAV and BAV patients. The mean prosthesis intercommissural distance, ratio was 1.03±0.1. The mean diameter of the prostheses at the annulus matched the mean perimeter-derived diameter of the aortic annulus at baseline with TAV (23.3±2.2 versus 23.6±1.9, P=0.4) and was smaller with BAV (24±2.8 versus 26.8±3.1, P<0.01), confirming 11% underexpansion in BAV. Finally, in situ, prosthesis diameter and ellipticity followed the same pattern, with stable values from the distal edge to 12 mm above, in both groups.

CONCLUSIONS: Second-generation prostheses similarly reshape the aortic annulus in TAV and BAV. Prostheses keep consistent diameters from distal edge to 12 mm in TAV and BAV. Prosthesis underexpansion is constantly observed in BAV. Annular-based sizing is accurate in BAV with minimal oversizing. The intercommissural distance, 4 mm above the annulus, could be integrated in gray zones.

CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03495050.

OriginalsprogEngelsk
TidsskriftCirculation. Cardiovascular interventions
Vol/bind12
Udgave nummer1
Sider (fra-til)e007107
ISSN1941-7640
DOI
StatusUdgivet - jan. 2019

ID: 59141457