Definition of trAnscatheter heart Valve orIeNtation in biCuspId aortic valve: The DA VINCI pilot study
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Why the study?
Whether standard transcatheter heart valve commissural alignment techniques are effective at reducing neo-commissural overlap with coronary ostia in bicuspid aortic valve anatomy had not been studied.
Comparison
Evolut Pro/Pro+ (n=23) vs Acurate Neo2 (n=11) implanted with cusp overlap view-based alignment
Design
Prospective registry pilot study
Authors
Discussion
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Implication
Standard alignment yields frequent coronary overlap and reduced selective access in BAV TAVR; leaves open whether ostial-overlap techniques improve results.
Structured PICO
P
Population
34 patients with severe type 1 bicuspid aortic valve (BAV) stenosis with right-left raphe undergoing transcatheter aortic valve replacement (TAVR)
I
Intervention
TAVR with last generation supra-annular tall-frame transcatheter heart valves (Evolut Pro/Pro + or Acurate Neo2) implanted with a cusp overlap view-based commissural alignment
O
Outcome
Rate of favorable THV/coronary overlap, defined as an angle > 40° between the THV commissural post and coronary ostiasurrogate
Conventional cusp overlap view-based commissural alignment during TAVR in bicuspid aortic valves results in high rates of moderate/severe neo-commissure overlap with coronary ostia and reduced selective coronary access.
Cite This Study
Tarantini et al. (2022) studied this question.
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