Bicuspid valve CT registry of balloon-expandable TAVR: BETTER TAVR registry.
Catheter Cardiovasc Interv
; 104(1): 105-114, 2024 Jul.
Article
de En
| MEDLINE
| ID: mdl-38819623
ABSTRACT
BACKGROUND:
The anatomic substrate of bicuspid valves may lead to suboptimal TAVR stent expansion and geometry.AIM:
We evaluated determinants of stent geometry in bicuspid valves treated with Sapien transcatheter aortic valve replacement (TAVR) valves.METHODS:
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.RESULTS:
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).CONCLUSION:
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.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Valve aortique
/
Sténose aortique
/
Conception de prothèse
/
Prothèse valvulaire cardiaque
/
Enregistrements
/
Remplacement valvulaire aortique par cathéter
Limites:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Pays/Région comme sujet:
America do norte
Langue:
En
Journal:
Catheter Cardiovasc Interv
/
Catheter. cardiovasc. interv
/
Catheterization and cardiovascular interventions
Sujet du journal:
CARDIOLOGIA
Année:
2024
Type de document:
Article
Pays d'affiliation:
Canada
Pays de publication:
États-Unis d'Amérique