Author + information
- Hiroyuki Kawamori,
- Sunghan Yoon,
- Tarun Chakravarty,
- Yoshio Maeno,
- Mohammad Kashif,
- Yigal Abramowitz,
- Geeteshwar Mangat,
- Sharjeel Israr,
- Masaki Miyasaka,
- Tanya Rami,
- Hasan Jilaihawi,
- Wen Cheng,
- Rahul Sharma and
- Raj Makkar
Background: Bicuspid aortic valve (BAV) is regarded as a risk of uneven expansion and subsequent dysfunction of the transcatheter heart valve (THV). This study is to evaluate the valve geometry of Sapien 3 THV used with BAV patient in transcatheter aortic valve implantation (TAVI).
Methods: We included consecutive patients from the RESOLVE registry (NCT02318342) that had a contrast Multi-slice computed tomography (MSCT) before and after TAVI and had Sapien 3 THV implantation. The stent frame of each THV was assessed at 3 cross-sectional levels (inflow, mid, and outflow). Geometry of the stent frame was assessed for eccentricity (1 – minimum diameter/maximum diameter) and expansion rate (MSCT derived external valve area/nominal external valve area).
Results: A total of 216 patients had Sapien 3 THV implantation, 34 with BAV and 182 with tricuspid aortic valve (TAV). There was no significant difference in mean expansion rate between BAV and TAV (104.8±6.0% vs. 103.2±4.8%; p=0.15). Under expansion (expansion rate <90% at all three levels) was not observed. Mean THV eccentricity was higher in BAV than in TAV (5.7 ± 2.9 % vs. 3.4 ± 1.8 %; p <0.01). Sapien 3 THV with severe valve eccentricity (eccentricity>10% at all three levels) was not observed but that with moderate to severe valve eccentricity (eccentricity >5% at all three levels) was observed in 10.7%. The frequency of THV with moderate to severe eccentricity was higher in BAV than in TAV (25.7% vs. 7.0%; p=0.013). Stent fracture was not observed. Logistic regression analysis revealed the BAV patient and Leaflet calcium score (HU-850) to be independent determinants for Sapien 3 THV with moderate to severe eccentricity (odds ratio: 3.247 [1.171-9.007], p=0.0236, and 3.699 [1.131-10.389], p=0.013, respectively). There was no difference in frequency of paravalvular leak with ≥mild (28.6% vs 33.5%; p=0.832) and mean gradient (12.2 ± 4.9 mmHg vs. 11.5 ± 6.1; p=0.537), at follow-up transthoracic echocardiography in patients implanted Sapien 3 with and without moderate severe valve eccentricity.
Conclusions: Although Sapien 3 THV in BAV can have moderate to severe valve eccentricity, stable hemodynamic function on echocardiography is expected after TAVI.
Moderated Poster Contributions
Interventional Cardiology Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 12:45 p.m.-12:55 p.m.
Session Title: Refining TAVR Outcomes
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1224M-05
- 2017 American College of Cardiology Foundation