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Journal of cardiac surgery
Jun, 2022;37 (6): 1486-1496.

Rotation characteristics and neo-commissural alignment of transcatheter heart valve in type-0 bicuspid aortic valve.

Mi Chen, Yan Ding, Honglei Zhao, Junzhou Pu, Bo Yang, Huanyu Qiao, Wei Zhang, Tao Bai, Jinrong Xue, Wenhui Wu, Yongmin Liu, Lizhong Sun, Haibo Zhang
Author Information
  1. Mi Chen: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. ORCID
  2. Yan Ding: Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  3. Honglei Zhao: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  4. Junzhou Pu: Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  5. Bo Yang: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  6. Huanyu Qiao: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  7. Wei Zhang: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  8. Tao Bai: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  9. Jinrong Xue: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  10. Wenhui Wu: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  11. Yongmin Liu: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  12. Lizhong Sun: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  13. Haibo Zhang: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. ORCID
PMID: 35349188 DOI: 10.1111/jocs.16460

Abstract

AIMS: This study sought to characterize the rotation of the transcatheter heart valve (THV) and evaluate the neo-commissures overlap with coronary arteries in type-0 bicuspid aortic valve (BAV).
METHODS AND RESULTS: This was a single-center, 10-patient, retrospective observational cohort. Pre-TAVI computed tomography and procedural fluoroscopy were analyzed. Coplanar fluoroscopic views were coregistered to pre-TAVI computed tomography to characterize THV rotation and determine coronary overlap. The incidence of severe coronary artery overlap with one coronary artery was 90%. According to our prediction line, type-0 BAV has predicted a higher incidence of overlap with one coronary artery, but lower incidence with both coronary arteries compared to the tricuspid aortic valve (TAV). The rotational angles in two different phases were 3.8 ± 3.2° versus 11.8 ± 8.0° (p = .01) in patients with mixed cusp fusion. Commissural angles in final and initial deployment were 9.6 ± 6.6 versus 18.1 ± 11.0° (p = .021). Applying hypothetic "commissure-middle view" in 0°, ±5°, and ±10°, the incidence of overlap with one coronary artery are 20%, 40%, and 90% separately.
CONCLUSIONS: The THV rotation existed and was activated in the last 1/3 deploying phase. With the observed tendency of "automatic commissural alignment," applying the "commissure-middle" view in type-0 BAV may optimize valve alignment and avoid coronary artery overlap.

Keywords

bicuspid aortic valve commissural alignment transcatheter aortic valve implantation transcatheter heart valve (THV) valve in valve

References

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Grants

  1. /Beijing Municipal Administration of Hospitals
  2. /beijing natural science

MeSH Term

Aortic Valve
Aortic Valve Stenosis
Bicuspid Aortic Valve Disease
Heart Valve Prosthesis
Humans
Prosthesis Design
Retrospective Studies
Rotation
Transcatheter Aortic Valve Replacement
Treatment Outcome
Journal Article

Word Cloud

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