Supra-annular structure assessment for THV sizing in bicuspid aortic stenosis led to smaller device selection in 91.7% of patients and 100% procedural success at 30 days.
Observational (n=12)
Does supra-annular structure assessment using sequential balloon aortic valvuloplasty improve THV size selection and outcomes in patients with bicuspid AS undergoing TAVR?
A supra-annular structure-based sizing strategy using sequential balloon aortic valvuloplasty is feasible and safe for TAVR in patients with bicuspid AS, often resulting in the selection of smaller devices.
OBJECTIVES: To explore assessment of supra-annular structure for self-expanding transcatheter heart valve (THV) size selection in patients with bicuspid aortic stenosis (AS). BACKGROUND: Annulus-based device selection from CT measurement is the standard sizing strategy for tricuspid aortic valve before transcatheter aortic valve replacement (TAVR). Because of supra-annular deformity, device selection for bicuspid AS has not been systemically studied. METHODS: Twelve patients with bicuspid AS who underwent TAVR with self-expanding THVs were included in this study. To assess supra-annular structure, sequential balloon aortic valvuloplasty was performed in every 2 mm increments until waist sign occurred with less than mild regurgitation. Procedural results and 30 day follow-up outcomes were analyzed. RESULTS: Seven patients (58.3%) with 18 mm; three patients (25%) with sequential 18 mm, 20 mm; and only two patients (16.7%) with sequential 18 mm, 20 mm, and 22 mm balloon sizing were performed, respectively. According to the results of supra-annular assessment, a smaller device size (91.7%) was selected in all but one patient compared with annulus based sizing strategy, and the outcomes were satisfactory with 100% procedural success. No mortality and 1 minor stroke were observed at 30 d follow-up. The percentage of NYHA III/IV decreased from 83.3% (9/12) to 16.7% (2/12). No new permanent pacemaker implantation and no moderate or severe paravalvular leakage were found. CONCLUSIONS: A supra-annular structure based sizing strategy is feasible for TAVR in patients with bicuspid AS.
Liu et al. (Mon,) conducted a observational in Bicuspid aortic stenosis (n=12). Supra-annular structure assessment via sequential balloon aortic valvuloplasty vs. Annulus based sizing strategy was evaluated on Procedural success. Supra-annular structure assessment for THV sizing in bicuspid aortic stenosis led to smaller device selection in 91.7% of patients and 100% procedural success at 30 days.