Cusp Symmetry and Coronary Ostial Eccentricity and its Impact on Coronary Access Following TAVR

Xi Wang; Ole De Backer; Gintautas Bieliauskas; Ivan Wong; Vilhelmas Bajoras; Tian-Yuan Xiong; Yi Zhang; Klaus Fuglsang Kofoed; Mao Chen; Lars Sondergaard

doi:10.1016/j.jcin.2021.11.010

Cusp Symmetry and Coronary Ostial Eccentricity and its Impact on Coronary Access Following TAVR

Xi Wang, Ole De Backer, Gintautas Bieliauskas, Ivan Wong, Vilhelmas Bajoras, Tian-Yuan Xiong, Yi Zhang, Klaus Fuglsang Kofoed, Mao Chen, Lars Sondergaard

Department of Cardiology

39 Citations (Scopus)

Abstract

OBJECTIVES: The aim of this study was to assess cusp symmetry and coronary ostial eccentricity and its impact on coronary access following transcatheter aortic valve replacement (TAVR) using a patient-specific commissural alignment implantation technique.

BACKGROUND: TAVR implantation techniques to obtain neocommissural alignment have been introduced. The impact of cusp symmetry and coronary ostial eccentricity on coronary access after TAVR remains unknown.

METHODS: Cardiac computed tomographic scans from 200 tricuspid aortic valves (TAVs) and 200 type 1 bicuspid aortic valves (BAVs) were studied. Cusp symmetry and coronary ostial eccentricity were assessed. In addition, the right coronary cusp/left coronary cusp and right coronary artery (RCA)/left coronary artery (LCA) ostia overlap views were calculated and compared.

RESULTS: Severe cusp asymmetry (>135°) was more frequent in BAVs (52.5%) than in TAVs (2.5%) (P < 0.001), with the noncoronary cusp being the most common dominant cusp. The RCA ostium was found to be more often eccentric (>20°) than the LCA ostium (28% vs 6%, respectively; P < 0.001). Considering the right/left cusp overlap view, there was <20° deviation between the right coronary cusp-left coronary cusp centered line and the RCA-LCA centered line in 95% of all patients (TAV, 97%; BAV, 93%). The right/left cusp and coronary ostia overlap view differed by <10° and <20° fluoroscopic angulation in 75% and 98% of all cases, respectively.

CONCLUSIONS: Using the right/left cusp overlap view to obtain commissural alignment in TAVR is also an effective approach to implant one of the transcatheter heart valve commissures in the near center between both coronary ostia in most TAVs and type 1 BAVs. Preprocedural CT assessment remains crucial to assess cusp symmetry and coronary ostial eccentricity.

Original language	English
Journal	JACC: Cardiovascular Interventions
Volume	15
Issue number	2
Pages (from-to)	123-134
Number of pages	12
ISSN	1936-8798
DOIs	https://doi.org/10.1016/j.jcin.2021.11.010
Publication status	Published - 24 Jan 2022

Keywords

TAVR
cardiac CT
commissural alignment
coronary access
implantation technique

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10.1016/j.jcin.2021.11.010

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@article{22b229b862bd4d1cb75f2e0288e6ad5c,

title = "Cusp Symmetry and Coronary Ostial Eccentricity and its Impact on Coronary Access Following TAVR",

abstract = "OBJECTIVES: The aim of this study was to assess cusp symmetry and coronary ostial eccentricity and its impact on coronary access following transcatheter aortic valve replacement (TAVR) using a patient-specific commissural alignment implantation technique.BACKGROUND: TAVR implantation techniques to obtain neocommissural alignment have been introduced. The impact of cusp symmetry and coronary ostial eccentricity on coronary access after TAVR remains unknown.METHODS: Cardiac computed tomographic scans from 200 tricuspid aortic valves (TAVs) and 200 type 1 bicuspid aortic valves (BAVs) were studied. Cusp symmetry and coronary ostial eccentricity were assessed. In addition, the right coronary cusp/left coronary cusp and right coronary artery (RCA)/left coronary artery (LCA) ostia overlap views were calculated and compared.RESULTS: Severe cusp asymmetry (>135°) was more frequent in BAVs (52.5\%) than in TAVs (2.5\%) (P < 0.001), with the noncoronary cusp being the most common dominant cusp. The RCA ostium was found to be more often eccentric (>20°) than the LCA ostium (28\% vs 6\%, respectively; P < 0.001). Considering the right/left cusp overlap view, there was <20° deviation between the right coronary cusp-left coronary cusp centered line and the RCA-LCA centered line in 95\% of all patients (TAV, 97\%; BAV, 93\%). The right/left cusp and coronary ostia overlap view differed by <10° and <20° fluoroscopic angulation in 75\% and 98\% of all cases, respectively.CONCLUSIONS: Using the right/left cusp overlap view to obtain commissural alignment in TAVR is also an effective approach to implant one of the transcatheter heart valve commissures in the near center between both coronary ostia in most TAVs and type 1 BAVs. Preprocedural CT assessment remains crucial to assess cusp symmetry and coronary ostial eccentricity.",

keywords = "TAVR, cardiac CT, commissural alignment, coronary access, implantation technique",

author = "Xi Wang and \{De Backer\}, Ole and Gintautas Bieliauskas and Ivan Wong and Vilhelmas Bajoras and Tian-Yuan Xiong and Yi Zhang and Kofoed, \{Klaus Fuglsang\} and Mao Chen and Lars Sondergaard",

year = "2022",

month = jan,

day = "24",

doi = "10.1016/j.jcin.2021.11.010",

language = "English",

volume = "15",

pages = "123--134",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

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number = "2",

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TY - JOUR

T1 - Cusp Symmetry and Coronary Ostial Eccentricity and its Impact on Coronary Access Following TAVR

AU - Wang, Xi

AU - De Backer, Ole

AU - Bieliauskas, Gintautas

AU - Wong, Ivan

AU - Bajoras, Vilhelmas

AU - Xiong, Tian-Yuan

AU - Zhang, Yi

AU - Kofoed, Klaus Fuglsang

AU - Chen, Mao

AU - Sondergaard, Lars

PY - 2022/1/24

Y1 - 2022/1/24

N2 - OBJECTIVES: The aim of this study was to assess cusp symmetry and coronary ostial eccentricity and its impact on coronary access following transcatheter aortic valve replacement (TAVR) using a patient-specific commissural alignment implantation technique.BACKGROUND: TAVR implantation techniques to obtain neocommissural alignment have been introduced. The impact of cusp symmetry and coronary ostial eccentricity on coronary access after TAVR remains unknown.METHODS: Cardiac computed tomographic scans from 200 tricuspid aortic valves (TAVs) and 200 type 1 bicuspid aortic valves (BAVs) were studied. Cusp symmetry and coronary ostial eccentricity were assessed. In addition, the right coronary cusp/left coronary cusp and right coronary artery (RCA)/left coronary artery (LCA) ostia overlap views were calculated and compared.RESULTS: Severe cusp asymmetry (>135°) was more frequent in BAVs (52.5%) than in TAVs (2.5%) (P < 0.001), with the noncoronary cusp being the most common dominant cusp. The RCA ostium was found to be more often eccentric (>20°) than the LCA ostium (28% vs 6%, respectively; P < 0.001). Considering the right/left cusp overlap view, there was <20° deviation between the right coronary cusp-left coronary cusp centered line and the RCA-LCA centered line in 95% of all patients (TAV, 97%; BAV, 93%). The right/left cusp and coronary ostia overlap view differed by <10° and <20° fluoroscopic angulation in 75% and 98% of all cases, respectively.CONCLUSIONS: Using the right/left cusp overlap view to obtain commissural alignment in TAVR is also an effective approach to implant one of the transcatheter heart valve commissures in the near center between both coronary ostia in most TAVs and type 1 BAVs. Preprocedural CT assessment remains crucial to assess cusp symmetry and coronary ostial eccentricity.

AB - OBJECTIVES: The aim of this study was to assess cusp symmetry and coronary ostial eccentricity and its impact on coronary access following transcatheter aortic valve replacement (TAVR) using a patient-specific commissural alignment implantation technique.BACKGROUND: TAVR implantation techniques to obtain neocommissural alignment have been introduced. The impact of cusp symmetry and coronary ostial eccentricity on coronary access after TAVR remains unknown.METHODS: Cardiac computed tomographic scans from 200 tricuspid aortic valves (TAVs) and 200 type 1 bicuspid aortic valves (BAVs) were studied. Cusp symmetry and coronary ostial eccentricity were assessed. In addition, the right coronary cusp/left coronary cusp and right coronary artery (RCA)/left coronary artery (LCA) ostia overlap views were calculated and compared.RESULTS: Severe cusp asymmetry (>135°) was more frequent in BAVs (52.5%) than in TAVs (2.5%) (P < 0.001), with the noncoronary cusp being the most common dominant cusp. The RCA ostium was found to be more often eccentric (>20°) than the LCA ostium (28% vs 6%, respectively; P < 0.001). Considering the right/left cusp overlap view, there was <20° deviation between the right coronary cusp-left coronary cusp centered line and the RCA-LCA centered line in 95% of all patients (TAV, 97%; BAV, 93%). The right/left cusp and coronary ostia overlap view differed by <10° and <20° fluoroscopic angulation in 75% and 98% of all cases, respectively.CONCLUSIONS: Using the right/left cusp overlap view to obtain commissural alignment in TAVR is also an effective approach to implant one of the transcatheter heart valve commissures in the near center between both coronary ostia in most TAVs and type 1 BAVs. Preprocedural CT assessment remains crucial to assess cusp symmetry and coronary ostial eccentricity.

KW - TAVR

KW - cardiac CT

KW - commissural alignment

KW - coronary access

KW - implantation technique

UR - https://www.scopus.com/pages/publications/85122485037

U2 - 10.1016/j.jcin.2021.11.010

DO - 10.1016/j.jcin.2021.11.010

M3 - Journal article

C2 - 35057982

SN - 1936-8798

VL - 15

SP - 123

EP - 134

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 2

ER -

Cusp Symmetry and Coronary Ostial Eccentricity and its Impact on Coronary Access Following TAVR

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