Bicuspid valve CT registry of balloon-expandable TAVR: BETTER TAVR registry.
Details
Serval ID
serval:BIB_26821C661909
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Bicuspid valve CT registry of balloon-expandable TAVR: BETTER TAVR registry.
Journal
Catheterization and cardiovascular interventions
ISSN
1522-726X (Electronic)
ISSN-L
1522-1946
Publication state
Published
Issued date
07/2024
Peer-reviewed
Oui
Volume
104
Number
1
Pages
105-114
Language
english
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Publication Status: ppublish
Abstract
The anatomic substrate of bicuspid valves may lead to suboptimal TAVR stent expansion and geometry.
We evaluated determinants of stent geometry in bicuspid valves treated with Sapien transcatheter aortic valve replacement (TAVR) valves.
A multicenter retrospective registry of patients (February 2019 to August 2022) who underwent post-TAVR computed tomography to determine stent area (vs. nominal valve area) and stent ellipticity (maximum diameter/minimum diameter). Predictors of relative stent expansion (minimum area/average of inflow + outflow area) and stent ellipticity were evaluated in a multivariable regression model, including valve calcium volume (indexed by annular area), presence of raphe calcium, sinus diameters indexed by area-derived annular diameter, and performance of pre-dilation and post-dilation.
The registry enrolled 101 patients from four centers. The minimum stent area (vs. nominal area) was 88.1%, and the maximum ellipticity was 1.10, with both observed near the midframe of the valve in all cases. Relative stent expansion ≥90% was observed in 64/101 patients. The only significant predictor of relative stent expansion ≥90% was the performance of post-dilation (OR: 4.79, p = 0.018). Relative stent expansion ≥90% was seen in 86% of patients with post-dilation compared to 57% without (p < 0.001). The stent ellipticity ≥1.1 was observed in 47/101 patients. The significant predictors of stent ellipticity ≥1.1 were the indexed maximum sinus diameter (OR: 0.582, p = 0.021) and indexed intercommisural diameter at 4 mm (OR: 2.42, p = 0.001). Stent expansion has a weak negative correlation with post-TAVR mean gradient (r = -0.324, p < 0.001).
Relative stent expansion ≥90% was associated with the performance of post-dilation, and stent ellipticity ≥1.1 was associated with indexed intercommisural diameter and indexed maximum sinus diameter. Further studies to determine optimal deployment strategies in bicuspid valves are needed.
We evaluated determinants of stent geometry in bicuspid valves treated with Sapien transcatheter aortic valve replacement (TAVR) valves.
A multicenter retrospective registry of patients (February 2019 to August 2022) who underwent post-TAVR computed tomography to determine stent area (vs. nominal valve area) and stent ellipticity (maximum diameter/minimum diameter). Predictors of relative stent expansion (minimum area/average of inflow + outflow area) and stent ellipticity were evaluated in a multivariable regression model, including valve calcium volume (indexed by annular area), presence of raphe calcium, sinus diameters indexed by area-derived annular diameter, and performance of pre-dilation and post-dilation.
The registry enrolled 101 patients from four centers. The minimum stent area (vs. nominal area) was 88.1%, and the maximum ellipticity was 1.10, with both observed near the midframe of the valve in all cases. Relative stent expansion ≥90% was observed in 64/101 patients. The only significant predictor of relative stent expansion ≥90% was the performance of post-dilation (OR: 4.79, p = 0.018). Relative stent expansion ≥90% was seen in 86% of patients with post-dilation compared to 57% without (p < 0.001). The stent ellipticity ≥1.1 was observed in 47/101 patients. The significant predictors of stent ellipticity ≥1.1 were the indexed maximum sinus diameter (OR: 0.582, p = 0.021) and indexed intercommisural diameter at 4 mm (OR: 2.42, p = 0.001). Stent expansion has a weak negative correlation with post-TAVR mean gradient (r = -0.324, p < 0.001).
Relative stent expansion ≥90% was associated with the performance of post-dilation, and stent ellipticity ≥1.1 was associated with indexed intercommisural diameter and indexed maximum sinus diameter. Further studies to determine optimal deployment strategies in bicuspid valves are needed.
Keywords
Humans, Registries, Transcatheter Aortic Valve Replacement/adverse effects, Transcatheter Aortic Valve Replacement/instrumentation, Female, Male, Retrospective Studies, Aged, 80 and over, Treatment Outcome, Aortic Valve/diagnostic imaging, Aortic Valve/surgery, Aortic Valve/physiopathology, Prosthesis Design, Aged, Heart Valve Prosthesis, Aortic Valve Stenosis/diagnostic imaging, Aortic Valve Stenosis/surgery, Aortic Valve Stenosis/physiopathology, Bicuspid Aortic Valve Disease/diagnostic imaging, Bicuspid Aortic Valve Disease/surgery, Balloon Valvuloplasty/adverse effects, Risk Factors, United States, Stents, TAVR, balloon expandable valve, bicuspid valve, computed tomography
Pubmed
Web of science
Open Access
Yes
Create date
17/01/2025 5:20
Last modification date
24/02/2025 11:35