Key result
LIRA-guided TAVR sizing in bicuspid aortic valves achieves ~93% 30-day device success.
Why the study?
TAVR in bicuspid aortic valve anatomy remains challenging with heterogeneous outcomes and no standardized sizing strategy.
Does the LIRA method for TAVR sizing provide favorable clinical outcomes and reproducibility in patients with bicuspid aortic valve anatomy?
Cohort (n=215)
Yes
Does the LIRA method for TAVR sizing provide favorable clinical outcomes and reproducibility in patients with bicuspid aortic valve anatomy?
The LIRA method for TAVR sizing in bicuspid aortic valve anatomy is reproducible and associated with high rates of device success and clinical efficacy at 1 year.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It must be acknowledged that the LIRA method is relatively easy to adopt and does not require specific imaging skills, provided that image reconstructions in the systolic phase can be clearly identified. Until there is randomized validation for supra-annular sizing, outcomes obtained using the LIRA method remain hypothesis generating and at best confirm its feasibility and safety.”
“The rationale of the LIRA method is based on the observation that in bicuspid anatomy, the plane of maximal raphe protrusion (LIRA plane) represents the level with the greatest interaction between the [transcatheter heart valve] and the surrounding anatomy, where anchoring predominantly occurs. By relying on a single integrative measurement, the LIRA perimeter, which is not directly affected by raphe length or calcification pattern, this method may reduce operator-dependent variability and facilitate standardized decision-making in bicuspid anatomy.”
LIRA sizing was associated with high device success and reproducibility in BAV TAVR; extends single-center data but leaves open randomized validation.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) anatomy remains challenging, with heterogeneous outcomes and no standardized sizing strategy. The LIRA (level of implantation at the raphe) method is a bicuspid-dedicated approach that complements standard annular sizing with a single perimeter measurement at the raphe level. A previous single-center experience suggested favorable results. OBJECTIVES: The aim of this study was to evaluate clinical performance and reproducibility of the LIRA method for TAVR sizing in a large BAV multicenter cohort. METHODS: A total of 215 BAV patients undergoing TAVR with the LIRA method at 6 centers were retrospectively analyzed. Procedural and clinical outcomes were adjudicated according to Valve Academic Research Consortium 3 criteria and assessed at 30 days and 1 year. Available full-cycle computed tomographic data sets from external centers were reanalyzed in a blinded centralized core laboratory to assess reproducibility of the LIRA method. RESULTS: The application of the LIRA method led to prosthesis downsizing in 74.4% of cases. At 30 days, device success was 93%, and moderate or greater paravalvular leak had occurred in 4.6% of patients, new permanent pacemaker implantation in 10.7%, and stroke in 1.9%. At 1 year, all-cause mortality was 5.7%, and clinical efficacy was observed in 92.8% of patients. Clinical outcomes were consistent across centers. Prosthesis sizing agreement was excellent (κ = 0.85; 95% CI: 0.74-0.96), and perimeter concordance was good (intraclass correlation coefficient = 0.76; 95% CI: 0.63-0.85). CONCLUSIONS: In this large multicenter cohort, the LIRA method demonstrated good reproducibility across centers and was associated with favorable procedural and clinical outcomes in BAV patients undergoing TAVR. These findings support its clinical applicability as a bicuspid-dedicated sizing strategy.
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Barbara et al. (2026) conducted a cohort in Bicuspid aortic valve anatomy (n=215). LIRA method for TAVR sizing was evaluated on Device success at 30 days. TAVR sizing using the LIRA method in bicuspid aortic valve anatomy resulted in 93% device success at 30 days and 92.8% clinical efficacy at 1 year.
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