A recent article published ahead-of-print in the journal Catheter Cardiovasc Interv. discusses the value of supra-annular structure measurements for size selection of self-expanding transcatheter heart valve in patients with bicuspid aortic valve.

Dr. Liu et al. from the Zhejiang University School of Medicine, Hangzhou, China examined twelve patients with bicuspid AS who underwent TAVR with self-expanding THVs (1). To assess supra-annular structure, sequential balloon aortic valvuloplasty was performed with 2 mm increments until a waist sign occurred with less than mild regurgitation. Procedural results and 30 day follow-up outcomes were analyzed.

Seven patients (58.3%) with 18 mm; three patients (25%) with sequential 18 mm, 20 mm; and only two patients (16.7%) with sequential 18 mm, 20 mm, and 22 mm balloon sizing were performed, respectively. According to the results of supra-annular assessment, a smaller device size (91.7%) was selected in all but one patient compared with annulus based sizing strategy, and the outcomes were satisfactory with 100% procedural success. No mortality and 1 minor stroke were observed at 30 d follow-up. The percentage of NYHA III/IV decreased from 83.3% (9/12) to 16.7% (2/12). No new permanent pacemaker implantation and no moderate or severe paravalvular leakage were found.

The authors conclude that a supra-annular structure based sizing strategy is feasible for TAVR in patients with bicuspid AS.

These results are limited by the small number of observations and need further evaluation and comparison to standard annulus based sizing strategies. (2)

References:

1. Liu X, He Y, Zhu Q, et al. Supra-annular structure assessment for self-expanding transcatheter heart valve size selection in patients with bicuspid aortic valve. Catheter Cardiovasc Interv. 2018 Feb 5. doi: 10.1002/ccd.27467. [Epub ahead of print]

2. Philip F, Faza NN, Schoenhagen P, et al. Aortic annulus and root characteristics in severe aortic stenosis due to bicuspid aortic valve and tricuspid aortic valves: implications for transcatheter aortic valve therapies. Catheter Cardiovasc Interv. 2015;86(2):E88-98. doi: 10.1002/ccd.25948. Epub 2015 Apr 24.