Key result
Type 0 bicuspid aortic valve anatomy was associated with a lower risk of THV-related challenging left coronary artery access compared to tricuspid anatomy after TAVR (OR 0.42; 95% CI 0.20-0.89).
Why the study?
It is unknown whether there are differences in coronary access after TAVR between bicuspid and tricuspid aortic valve anatomy.
Does bicuspid aortic valve anatomy compared to tricuspid anatomy affect simulated coronary access feasibility after TAVR with a self-expanding valve?
Observational (n=288)
Does bicuspid aortic valve anatomy compared to tricuspid anatomy affect simulated coronary access feasibility after TAVR with a self-expanding valve?
Type 0 bicuspid aortic valve anatomy may be more favorable for post-TAVR coronary access compared to tricuspid anatomy when using self-expanding valves.
May favor Type 0 bicuspid anatomy for post-TAVR coronary access with self-expanding valves; leaves open prospective confirmation before practice change.
BACKGROUND: It is unknown whether there are differences in coronary access after transcatheter aortic valve replacement (TAVR) between bicuspid and tricuspid anatomy. AIMS: Our aim was to investigate coronary access after TAVR using a self-expanding transcatheter heart valve (THV) in bicuspid versus tricuspid aortic valves (BAV vs TAV), based on CT simulation. METHODS: A total of 86 type 0 BAV, 70 type 1 BAV, and 132 TAV patients were included. If the coronary ostium faced the sealed parts of the THV or the tilted-up native leaflet (NL), this was defined as THV- or NL-related challenging coronary access, respectively. If coaxial engagement was not allowed due to interference from the unwrapped frame, THV-related complex coronary access was defined. RESULTS: The incidence of THV-related challenging coronary access was 21.2% for the left coronary artery (LCA) and 17.7% for the right coronary artery (RCA), and type 0 BAV patients encountered fewer THV-related challenging LCA access than their TAV counterparts (OR 0.42, 95% CI: 0.20-0.89). NL-related challenging coronary access was observed in 3.1% for LCA and 1.4% for RCA, and THV-related complex coronary access was identified in 5.9% for LCA and 17.0% for RCA; however, no significant differences were found among groups. The proportion of optimal fluoroscopic viewing angles suitable for guiding LCA engagement was similar among groups (64.0% vs 70.0% vs 62.1%), but those suitable for guiding RCA engagement were significantly higher in the type 0 BAV group (31.4% vs 4.3% vs 9.1%). CONCLUSIONS: Coronary access may be challenging or complex in a significant proportion of both BAV and TAV patients after TAVR. Type 0 BAV anatomy may be more favourable for post-TAVR coronary access.
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A 2022 study conducted an observational in Aortic stenosis (n=288). Bicuspid aortic valve anatomy vs. Tricuspid aortic valve anatomy was evaluated on THV-related challenging left coronary artery (LCA) access (OR 0.42, 95% CI 0.20-0.89). Type 0 bicuspid aortic valve anatomy was associated with a lower risk of THV-related challenging left coronary artery access compared to tricuspid anatomy after TAVR (OR 0.42; 95% CI 0.20-0.89).
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