scholarly journals Characteristics of aortic root and vascular anatomy in bicuspid versus tricuspid aortic valve anatomy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Hamdan ◽  
G Witberg ◽  
G Perlman ◽  
Y Aviv ◽  
A Shiyovich ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Vascular Calcification ◽  
Aortic Root ◽  
Vascular Complications ◽  
Vascular Anatomy ◽  
Bicuspid Valve ◽  
Transcatheter Aortic Valve ◽  
Ct Evaluation ◽  
Baseline Characteristics ◽  
The Impact

Abstract Background Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS). Purpose This study sought to compare aortic root, aorta and iliofemoral artery anatomy in patients with bicuspid versus tricuspid AS. Methods 172 patients with bicuspid AS and 331 patients with tricuspid AS underwent pre-procedural computed tomography (CT) evaluation before TAVR. Dimensions, calcification, and tortuosity of the iliofemoral arteries were evaluated and the dimensions of aortic root, aorta, and left subclavian arteries were determined. Results Dimensions of aortic root, aorta, left subclavian, and iliofemoral arteries were consistently and significantly larger in bicuspid than in tricuspid AS (P<0.001). Patients with bicuspid AS had significantly lower subclavian, aorta, and iliofemoral arteries calcification, lower tortuosity index and lower maximal tortuosity angle compared to patients with tricuspid AS (P<0.001 for all) even after adjustment for baseline characteristics (Figure). Compared to tricuspid AS the prevalence of porcelain aorta and aneurysm in the descending aorta and iliofemoral arteries were significantly less common in bicuspid valve anatomy. After adjustment for baseline characteristics Bicuspid valve anatomy was associated with lower odds of vascular calcification (odds ratio (OR) 0.82: 95% CI 0.52–0.93; P=0.001). Conclusions Bicuspid AS was associated with larger dimensions of aortic root, aorta, subclavian, and iliofemoral arteries compared with tricuspid AS. Low vascular calcification and decreased tortuosity index of iliofemoral arteries characterized bicuspid anatomy. Further studies are needed to evaluate the impact of bicuspid vascular anatomy on vascular complications after TAVR. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Numerical Parametric Study of Paravalvular Leak Following a Transcatheter Aortic Valve Deployment Into a Patient-Specific Aortic Root

2018 ◽  
Vol 140 (10) ◽  
Author(s):  
Wenbin Mao ◽  
Qian Wang ◽  
Susheel Kodali ◽  
Wei Sun
Keyword(s):  
Aortic Valve ◽  
Computational Model ◽  
Aortic Root ◽  
Paravalvular Leak ◽  
Patient Specific ◽  
Fe Method ◽  
Transcatheter Aortic Valve ◽  
Operative Planning ◽  
The Difference ◽  
The Impact

Paravalvular leak (PVL) is a relatively frequent complication after transcatheter aortic valve replacement (TAVR) with increased mortality. Currently, there is no effective method to pre-operatively predict and prevent PVL. In this study, we developed a computational model to predict the severity of PVL after TAVR. Nonlinear finite element (FE) method was used to simulate a self-expandable CoreValve deployment into a patient-specific aortic root, specified with human material properties of aortic tissues. Subsequently, computational fluid dynamics (CFD) simulations were performed using the post-TAVR geometries from the FE simulation, and a parametric investigation of the impact of the transcatheter aortic valve (TAV) skirt shape, TAV orientation, and deployment height on PVL was conducted. The predicted PVL was in good agreement with the echocardiography data. Due to the scallop shape of CoreValve skirt, the difference of PVL due to TAV orientation can be as large as 40%. Although the stent thickness is small compared to the aortic annulus size, we found that inappropriate modeling of it can lead to an underestimation of PVL up to 10 ml/beat. Moreover, the deployment height could significantly alter the extent and the distribution of regurgitant jets, which results in a change of leaking volume up to 70%. Further investigation in a large cohort of patients is warranted to verify the accuracy of our model. This study demonstrated that a rigorously developed patient-specific computational model can provide useful insights into underlying mechanisms causing PVL and potentially assist in pre-operative planning for TAVR to minimize PVL.

scholarly journals Anatomical predictors of conduction damage after transcatheter implantation of the aortic valve

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000972 ◽  
Author(s):  
Justin T Tretter ◽  
Shumpei Mori ◽  
Robert H Anderson ◽  
Michael D Taylor ◽  
Nicholas Ollberding ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Anatomical Variation ◽  
Radial Force ◽  
Adverse Outcomes ◽  
Bundle Branch Block ◽  
Inferior Margin ◽  
Transcatheter Aortic Valve ◽  
The Impact ◽  
Membranous Septum

ObjectiveConduction damage following transcatheter aortic valve implantation (TAVI) remains common. Anatomical risk factors remain elusive. We assessed the impact of variability in the dimensions of the membranous septum and position of the aortic root on the occurrence of conduction damage following TAVI.MethodsThe dimensions of the membranous septum, the rotational position of the aortic root correlating to variability in the central fibrous body width, and wedging of the aortic root were assessed on pre-TAVI CT datasets. The depth of implantation was measured from the final aortic angiogram. The variables were compared with the occurrence of both permanent pacemaker insertion (PPI) and left bundle branch block (LBBB) following TAVI.ResultsOf 200 patients who met inclusion criteria (mean age = 81 years ± 7.7, 49% men), 20.5 % underwent PPI after TAVI. New LBBB occurred in 23.5%, 21.3 % of whom required PPI. Preprocedural right bundle branch block (OR = 7.00; CI 3.13 to 15.64), valve type (OR=2.35; CI 1.13 to 4.87), depth of implantation (OR=1.62; CI 1.01 to 2.61) and the difference between depth of implantation and the distance from the virtual basal ring to the inferior margin of the membranous septum (OR=0.61; CI 0.38 to 0.99) were all associated with PPI, with similar associations with LBBB. No gross anatomical variable alone was associated with conduction damage.ConclusionsGross anatomical variation of the aortic root and its underlying support, including the membranous septum, were not associated with the occurrence of either PPI or new LBBB. Procedural characteristics associated with these adverse outcomes suggest that the depth of implantation and radial force of the bioprosthesis, regardless of gross anatomical variability, increase the risk for conduction damage.

P1601 Relationship between aortic distensibility and aortic regurgitation assessed by CMR in bicuspid valve patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L La Mura ◽  
G Teixido-Tura ◽  
A Guala ◽  
A Ruiz-Munoz ◽  
A Lopez Sainz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Bicuspid Aortic Valve ◽  
Aortic Root ◽  
Phase Contrast ◽  
Aortic Distensibility ◽  
Regurgitant Fraction ◽  
Descending Aorta ◽  
Bicuspid Valve ◽  
The Impact

Abstract Funding Acknowledgements Spanish Ministry of Economy and Competitiveness RTC-2016-5152-1, ISCIII PI17/00381, La Marató de TV3 (20151330), Eur FP7/People 267128 and CIBERCV BACKGROUND The severity of aortic regurgitation can be evaluated with cardiac magnetic resonance (CMR) through calculation of regurgitant fraction (RF) in phase contrast sequences acquired at the aortic root (as close as possible to the aortic valve). However, the impact of aortic distensibility in this evaluation remains unkown. PURPOSE The aim of the study was to evaluate the relation between aortic distensibility and RF valve in bicuspid aortic valve patients. METHODS We enrolled bicuspid aortic valve patients without significant aortic stenosis (maximum velocity <2.5 m/s) and connective tissue disease. All patients underwent a CMR study with phase contrast sequences for evaluation of regurgitant fraction at the level of the aortic valve. Aortic regurgitation was considered as mild, moderate or severe depending on RF value (mild <15%; moderate 15-30%; severe >30%). Furthermore we used cine-sequences of aortic root, ascending and proximal descending aorta to estimate aortic diameters and distensibilities, using Art Fun software. Distensibility was calculated as (change in aortic area between systole and diastole/diastolic area)/brachial pulse pressure. RESULTS A total of 98 bicuspid aortic valve patients were included (30% female, 49.7 ± 14.5 years). 75 (76,5%) AR was mild, 17 (17,4%) moderate and 6 (6,1%) severe. RF valvewas significantly correlated with aortic root diameter (r= 0.430 y p < 0.001 )and aortic distensibility at the level of the ascending (r = 0.273 p =0.016) and descending aorta (r = 0.502 and p< 0.001). Aortic distensibility was positively correlated with RFvalve even after adjustment for aortic diameter ( p = 0.002 and p <0.001 respectively) . (Table) (IMG) CONCLUSIONS In our study, aortic regurgitation in bicuspid valve patients, evaluated by CMR using RF valve, is related to aortic distensibility. Thus, aortic distensibility should be included in the evaluation of aortic regurgitation by CMR as additional parameter. However, longitudinal studies are needed to evaluate the impact of including aortic distensibility in the evaluation of AR severity by CMR. AR SEVERITY MILD MODERATE SEVERE Descending aorta distensibility(mean ± std. deviation) 2693,68 ± 997,5 3285,8 ±1952,7 5042,99 ±2873,44 Correlation between AR severity (by RFvalve) and descending aorta distensibility Abstract P1601 Figure.

Management and Prevention of Vascular Complications Related to Transcatheter Aortic Valve Implantation and Aortic Aneurysm Repair Procedures – A Technical Note

2010 ◽  
Vol 5 (1) ◽  
pp. 81
Author(s):  
Andrea Pacchioni ◽  
Dimitris Nikas ◽  
Carlo Penzo ◽  
Salvatore Saccà ◽  
Luca Favero ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Vascular Complications ◽  
Technical Note ◽  
Closure Device ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) and endovascular aortic repair (EVAR) are increasingly being used as therapeutic options for patients with severe aortic stenosis who are ineligible for surgery and who have aortic aneurysm with suitable anatomical features. These procedures can be associated with severe complications, especially related to vascular access and the use of a large introducer sheath (from 18 to 24 French [Fr]). In this article we describe possible vascular complications emerging during TAVI and EVAR and their appropriate management, beginning with patient selection, the correct way to perform vessel puncture and the use of a vascular closure device, up to the recently proposed cross-over technique, which is thought to minimise the risk of dangerous consequences of vascular damage.

scholarly journals THE IMPACT OF AORTIC ANGULATION ON CONTEMPORARY TRANSCATHETER AORTIC VALVE REPLACEMENT

2021 ◽  
Vol 77 (18) ◽  
pp. 1129
Author(s):  
Giorgio Medranda ◽  
Cheng Zhang ◽  
Brian Case ◽  
Charan Yerasi ◽  
Brian Forrestal ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
The Impact
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