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Comparison of multislice CT findings between bicuspid and tricuspid aortic valves before and after TAVI

Publication
Philips CT Clinical Science Philips Healthcare • USA

Watanabe Y, Chevalier B, Hayashida K, Leong T, Bouvier E, Arai T, Farge A, Hovasse T, Garot P, Cormier B, Morice MC, Lefèvre T.

* This article originally appeared in the August 2015 edition of Catherterization and Cardiovascular Intervention.
Aims
This study sought to compare the multislice computed tomography (MSCT) characteristics of bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV) before and after implantation of the CoreValve (Medtronic, Santa Rosa, California) or the Edwards SapienXT (Edwards Lifesciences, Irvine, CA).

Methods and Results
From March 2009 to March 2013, a total of 67 TAVI patients who had both pre- and post-procedural MSCT were studied. Eleven patients underwent TAVI in BAV with the CoreValve (n = 6) or SapienXT (n = 5) and 56 patients underwent TAVI in TAV with the CoreValve (n = 38) or SapienXT (n = 18). The BAV group was similar to the TAV group except for a higher pre-procedural mean pressure gradient (53.1 ± 17.4 vs. 48.8 ± 20.4 mm Hg, P = 0.03), a larger annulus perimeter (89.3 ± 9.0 vs. 81.8 6 8.1 mm, P = 0.03) and a higher aortic valve calcium volume (1262.7 ± 396.0 vs. 556.4 ± 461.9 mm³, P < 0.01). In the CoreValve group, post-procedural mean pressure gradient was significantly higher in the BAV group (11.0 ± 2.6 vs. 8.2 ± 2.8 mm Hg, P = 0.04) and a smaller valve area/pre-annulus area ratio was observed at each level of the prosthesis (base of the stent frame 81.7% ± 14.9% vs. 94.7% ± 15.0%, P = 0.06, annulus level 74.3% ± 16.7% vs. 89.9% ± 10.5%, P = 0.03, leaflet level 64.6% ± 13.1% vs. 81.2% ± 13.2%, P< 0.01). This was not observed in the Edwards group.

Conclusions
Compared to TAV, patients with BAV have higher gradients, larger annulus perimeters and more calcified valves. Higher post procedural gradient and valve underexpansion were frequently observed after CoreValve implantation. Further MSCT study is required to demonstrate the efficacy of TAVI in BAV. This study sought to compare the CT characteristics of bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV) before and after implantation of the CoreValve or the Edwards SapienXT. Eleven patients who underwent TAVI in BAV with the CoreValve (n = 6) or SapienXT (n = 5) and 56 patients who underwent TAVI in TAV with the CoreValve (n = 38) or SapienXT (n = 18) were studied. Compared to TAV, patients with BAV have higher gradients, larger annulus perimeters and more calcified valves. Higher post procedural gradient and valve underexpansion were observed after CoreValve implantation. Further MSCT study is required to demonstrate the efficacy of TAVI in BAV.
For more information about this publication, check out the PubMed listing for this article.


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Publication
Brilliance 64-channel
aorta, Body, Cardiac, Extended Brilliance Workspace, implant, Interventional, TAVI, transcatheter aortic valve implantation, Valves, Vascular
 

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