Anna S Petronio1, Marco Angelillis2, Ole De Backer3, Cristina Giannini1, Giulia Costa1, Claudia Fiorina4, Fausto Castriota5, Francesco Bedogni6, Jean C Laborde7, Lars Søndergaard3. 1. Cardiothoracic and Vascular Department, University Hospital Pisa, Italy. 2. Cardiothoracic and Vascular Department, University Hospital Pisa, Italy. Electronic address: emodinamica@ao-pisa.toscana.it. 3. The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 4. Ospedali Civili Brescia, Italy. 5. Cardiovascular Department, Humanities Gavazzeni, Bergamo, Italy. 6. S.Donato Hospital, S.Donato Milan, Italy. 7. St. George Hospital, London, UK.
Abstract
BACKGROUND: No indication are available for transcatheter aortic valve implantation (TAVI) sizing in bicuspid aortic valve (BAV). Aim of the study is to develop and validate a Multi-Slice Computed Tomography (MSCT)-based algorithm for transcatheter heart valve (THV) sizing in patients with stenotic BAV under evaluation for TAVI. METHODS: A two steps method was applied: 1)evaluation of a cohort of 19 consecutive patients with type I BAV stenosis undergoing TAVI through pre and post-procedural MSCT, and development of an algorithm for THV sizing; 2)validation of the algorithm on a new cohort of 21 patients. RESULTS: In the first cohort, a high correlation was found between the raphe-level area measured at pre-procedural MSCT and the smallest THV area measured at post-procedural MSCT (p < 0.001). Moreover, reduced THV expansion was observed among patients with higher calcium burden (p = 0.048). Then, a new algorithm for TAVI sizing in BAV was develop (CASPER: Calcium Algorithm Sizing for bicusPid Evaluation with Raphe). This algorithm is based on the reassessment of the perimeter/area derived annulus diameter, according to three main anatomical features: 1) the ratio between raphe length and annulus diameter; 2)calcium burden; 3)calcium distribution in relation to the raphe. The algorithm was then validated in a new cohort of 21 patients, achieving 100% of procedural success and excellent TAVI performance. CONCLUSION: MSCT assessment of raphe length, calcium burden and its distribution is of crucial relevance in the pre-procedural evaluation of patients with BAV. These anatomical features can be combined in a new and simple algorithm for TAVI sizing.
BACKGROUND: No indication are available for transcatheter aortic valve implantation (TAVI) sizing in bicuspid aortic valve (BAV). Aim of the study is to develop and validate a Multi-Slice Computed Tomography (MSCT)-based algorithm for transcatheter heart valve (THV) sizing in patients with stenotic BAV under evaluation for TAVI. METHODS: A two steps method was applied: 1)evaluation of a cohort of 19 consecutive patients with type I BAV stenosis undergoing TAVI through pre and post-procedural MSCT, and development of an algorithm for THV sizing; 2)validation of the algorithm on a new cohort of 21 patients. RESULTS: In the first cohort, a high correlation was found between the raphe-level area measured at pre-procedural MSCT and the smallest THV area measured at post-procedural MSCT (p < 0.001). Moreover, reduced THV expansion was observed among patients with higher calcium burden (p = 0.048). Then, a new algorithm for TAVI sizing in BAV was develop (CASPER: Calcium Algorithm Sizing for bicusPid Evaluation with Raphe). This algorithm is based on the reassessment of the perimeter/area derived annulus diameter, according to three main anatomical features: 1) the ratio between raphe length and annulus diameter; 2)calcium burden; 3)calcium distribution in relation to the raphe. The algorithm was then validated in a new cohort of 21 patients, achieving 100% of procedural success and excellent TAVI performance. CONCLUSION: MSCT assessment of raphe length, calcium burden and its distribution is of crucial relevance in the pre-procedural evaluation of patients with BAV. These anatomical features can be combined in a new and simple algorithm for TAVI sizing.
Authors: Tian-Yuan Xiong; Walid Ben Ali; Yuan Feng; Kentaro Hayashida; Hasan Jilaihawi; Azeem Latib; Michael Kang-Yin Lee; Martin B Leon; Raj R Makkar; Thomas Modine; Christoph Naber; Yong Peng; Nicolo Piazza; Michael J Reardon; Simon Redwood; Ashok Seth; Lars Sondergaard; Edgar Tay; Didier Tchetche; Wei-Hsian Yin; Mao Chen; Bernard Prendergast; Darren Mylotte Journal: Nat Rev Cardiol Date: 2022-06-20 Impact factor: 32.419
Authors: Ole de Backer; Tobias Zeus; Verena Veulemans; Philippe Nuyens; Shouheng Goh; Oliver Maier; Stephan Binnebößel; Jacqueline Heermann; Christian Jung; Ralf Westenfeld; Malte Kelm Journal: Clin Res Cardiol Date: 2022-06-29 Impact factor: 5.460
Authors: Aleksandra Gasecka; Michał Walczewski; Adam Witkowski; Maciej Dabrowski; Zenon Huczek; Radosław Wilimski; Andrzej Ochała; Radosław Parma; Piotr Scisło; Bartosz Rymuza; Karol Zbroński; Piotr Szwed; Marek Grygier; Anna Olasińska-Wiśniewska; Dariusz Jagielak; Radosław Targoński; Grzegorz Opolski; Janusz Kochman Journal: Front Cardiovasc Med Date: 2022-06-21
Authors: Daniel Blackman; Davide Gabbieri; Bruno García Del Blanco; Jörg Kempfert; Mika Laine; Julia Mascherbauer; Radoslaw Parma; Didier Tchétché Journal: Cardiol Ther Date: 2021-06-03
Authors: Nils Perrin; Réda Ibrahim; Nicolas Dürrleman; Arsène Basmadjian; Lionel Leroux; Philippe Demers; Thomas Modine; Walid Ben Ali Journal: Front Cardiovasc Med Date: 2022-02-08
Authors: Ahmed Elkoumy; John Jose; Christian J Terkelsen; Henrik Nissen; Sengottuvelu Gunasekaran; Mahmoud Abdelshafy; Ashok Seth; Hesham Elzomor; Sreenivas Kumar; Francesco Bedogni; Alfonso Ielasi; Santosh K Dora; Sharad Chandra; Keyur Parikh; Daniel Unic; William Wijns; Andreas Baumbach; Darren Mylotte; Patrick Serruys; Osama Soliman Journal: J Clin Med Date: 2022-01-15 Impact factor: 4.241