Bicuspid aortic valves had a significantly larger annulus area (5.21 vs 4.63 cm2, P=0.0001) and were more circular (39% vs 4%, P<0.001) compared to tricuspid aortic valves.
Cohort (n=400)
Do aortic root and annulus characteristics differ between patients with severe aortic stenosis due to bicuspid versus tricuspid aortic valves?
Bicuspid aortic valves have larger, more circular annuli compared to tricuspid valves, suggesting that most BAV annuli would fit currently available commercial valved stents for TAVR.
Absolute Event Rate: 5.21% vs 4.63%
p-value: p=0.0001
BACKGROUND: Patients with severe aortic stenosis due to BAV are excluded from transcatheter aortic valve replacement (TAVR) due to concern for asymmetric expansion and valve dysfunction. We sought to characterize the aortic root and annulus in bicuspid aortic valve (BAV) and tricuspid aortic valves (TAV). METHODS AND RESULTS: We identified patients with severe AS who underwent multi-detector computed tomographic (MDCT) imaging prior to surgical aortic valve replacement (SAVR, n = 200) for BAV and TAVR (n = 200) for TAV from 2010 to 2013. The presence of a BAV was confirmed on surgical and pathological review. Annulus measurements of the basal ring (short- and long-axis, area-derived diameter), coronary ostia height, sinus area (SA), sino-tubular junction area (STJ), calcification and eccentricity index (EI, 1-short axis/long axis) were made. Patients with TAV were older (78.8 years vs. 57.8 years, P = 0.04) than those with BAV. The aortic annulus area (5.21 ± 2.1 cm(2) vs. 4.63 ± 2.0 cm(2) , P = 0.0001), sinus of Valsalva diameter (3.7 ± 0.9 cm vs. 3.1 ± 0.1 cm, P = 0.001) and ascending aorta diameter (3.5 ± 0.7 cm vs. 2.97 ± 0.6 cm, P = 0.001) were significantly larger with BAV. Bicuspid aortic annuli were significantly less elliptical (EI, 1.24 ± 0.1 vs. 1.29 ± 0.1, P = 0.006) and more circular (39% vs. 4%, P < 0.001) compared to the TAV annulus. There was more eccentric annular calcification in BAV vs. TAV (68% vs. 32%, P < 0.001). The mean distance from the aortic annulus to the left main coronary ostium was less than the right coronary ostium. Less than 10% of the BAV annuli would not fit a currently available valved stents. CONCLUSION: Bicuspid aortic valves have a larger annulus size, sinus of Valsalva and ascending aorta dimensions. In addition, the BAV aortic annuli appear circular and most will fit currently available commercial valved stents.
Philip et al. (2015) conducted a cohort in Severe aortic stenosis (n=400). Bicuspid aortic valve (BAV) vs. Tricuspid aortic valve (TAV) was evaluated on Aortic annulus area (p=0.0001). Bicuspid aortic valves had a significantly larger annulus area (5.21 vs 4.63 cm2, P=0.0001) and were more circular (39% vs 4%, P<0.001) compared to tricuspid aortic valves.