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. 2022 Dec 20;135(24):2968-2975.
doi: 10.1097/CM9.0000000000002517.

Anatomical morphology of the aortic valve in Chinese aortic stenosis patients and clinical results after downsize strategy of transcatheter aortic valve replacement

Guannan Niu  1 , Walid Ben Ali  2 , Moyang Wang  1 , Hasan Jilaihawi  3 , Haitong Zhang  1 , Qian Zhang  1 , Yunqing Ye  1 , Xinmin Liu  4 , Jing Yao  4 , Qinghao Zhao  1 , Yubin Wang  1 , Zheng Zhou  1 , Lizhi Zhang  5 , Xinshuang Ren  6 , Yunqiang An  6 , Bin Lu  6 , Thomas Modine  7 , Yongjian Wu  1 , Guangyuan Song  4
Affiliations

Anatomical morphology of the aortic valve in Chinese aortic stenosis patients and clinical results after downsize strategy of transcatheter aortic valve replacement

Guannan Niu et al. Chin Med J (Engl). .

Abstract

Background: The study aimed to describe the aortic valve morphology in Chinese patients underwent transcatheter aortic valve replacement (TAVR) for symptomatic severe aortic stenosis (AS), and the impact of sizing strategies and related procedural outcomes.

Methods: Patients with severe AS who underwent TAVR were consecutively enrolled from 2012 to 2019. The anatomy and morphology of the aortic root were assessed. "Downsize" strategy was preformed when patients had complex morphology. The clinical outcomes of patients who performed downsize strategy were compared with those received annular sizing strategy. The primary outcome was device success rate, and secondary outcomes included Valve Academic Research Consortium-3 clinical outcomes variables based on 1-year follow-up.

Results: A total of 293 patients were enrolled. Among them, 95 patients (32.4%) had bicuspid aortic valve. The calcium volume (Hounsfield Unit-850) of aortic root was 449.90 (243.15-782.15) mm 3 . Calcium is distributed mostly on the leaflet level. Downsize strategy was performed in 204 patients (69.6%). Compared with the patients who performed annular sizing strategy, those received downsize strategy achieved a similar device success rate (82.0% [73] vs . 83.3% [170], P = 0.79). Aortic valve gradients (downsize strategy group vs . annular sizing group, 11.28 mmHg vs. 11.88 mmHg, P = 0.64) and percentages of patients with moderate or severe paravalvular regurgitation 2.0% (4/204) vs . 4.5% (4/89), P = 0.21) were similar in the two groups at 30 days after TAVR. These echocardiographic results were sustainable for one year.

Conclusions: Chinese TAVR patients have more prevalent bicuspid morphology and large calcium volume of aortic root. Calcium is distributed mostly on the leaflet level. Compare with annular sizing strategy, downsize strategy provided a non-inferior device success rate and transcatheter heart valve hemodynamic performance in self-expanding TAVR procedure.

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Conflict of interest statement

Dr. Walid Ben Ali has received a research grant from Medtronic and Edward LifeSciences. Dr. Thomas Modine serves as a consultant to Abbott, Boston Scientific, Edwards Lifesciences, GE, Medtronic, and MicroPort.

Figures

Figure 1
Figure 1
Calcium assessment and leaflets measurement of aortic stenosis patients. (A) The aortic root was divided into five specific regions. LVOT region: from 6 mm below the annular plane to 2 mm below the annular plane; Annulus region: from 2 mm below the annular plane to 2 mm superior to the annular plane; Lower leaflet region: from 2 mm superior to the annular plane to 6 mm superior to the annular plane; Mid leaflet region: from 6 mm superior to the annular plane to 10 mm superior to the annular plane; Upper leaflet region: from 10 mm superior to the annular plane to the sinotubular junction level; (B) Calcium quantification by leaflet sector: Purple, yellow and blue represent the left, right and none coronary leaflet sectors respectively; (C) Leaflets thickness and fusion between measurements for TAV and Type-1 BiAV: Length A (red line): Commissure to opposite sinus measurement; Length B (yellow imaginary line): Fusion length between leaflets (measured as commissure to the very point the leaflet separated); Length C (blue imaginary line): Thickness of leaflet (measured as the high-density or low-density tissue between the sinus of Valsalva and aortic valve orifice); (D) Leaflets thickness and fusion between measurements for Type-0 BiAV: Length A (red line): Mid sinus-sinus measurement; Length B (purple line): Inter-commissural distance (the distance between commissures of the respective opposing leaflets); Length C (yellow imaginary line): Fusion between leaflets (measured as commissure to the very point the leaflet separated); Length D (blue imaginary line): Thickness of leaflet (measured as the high-density or low-density tissue between the sinus of Valsalva and aortic valve orifice). LC: Left coronary; LVOT: Left ventricular outflow tract; NC: Non coronary; RC: Right coronary; TAV: Transcatheter aortic valve; Type-1 BiAV: Sievers type-1 bicuspid aortic valve; Type-0 BiAV: Sievers type-0 bicuspid aortic valve.
Figure 2
Figure 2
Calcium volume scores at different levels of the aortic root in aortic stenosis patients. (A) Volume scores in all patients. (B) Volume scores in patients with TriAV. (C) Volume scores in patients with BiAV. (D) Volume scores in patients with Sievers type-1 bicuspid aortic valve. (E) Volume scores in patients with Sievers type-0 bicuspid aortic valve. BiAV: Bicuspid aortic valve; LVOT: Left ventricular outflow tract; TriAV: Tricuspid aortic valve.
Figure 3
Figure 3
Fusion between leaflets of aortic stenosis patients. BiAV: Bicuspid aortic valve; TriAV: Tricuspid aortic valve; Type-1 BiAV: Sievers type-1 bicuspid aortic valve; Type-0 BiAV: Sievers type-0 bicuspid aortic valve.
Figure 4
Figure 4
Echocardiographic findings of aortic stenosis patients. (A) Mean pressure gradients from baseline to one year for patients in annulus sizing and downsize groups. (B) Paravalvular aortic regurgitation incidence. The incidence of paravalvular aortic regurgitation in the downsize versus annulus sizing groups is shown at various follow-up time points. TAVR: Transcatheter aortic valve replacement.
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References

    1. Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, et al. . Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med 2014; 370:1790–1798. doi: 10.1056/NEJMoa1400590. - PubMed
    1. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. . Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363:1597–1607. doi: 10.1056/NEJMoa1008232. - PubMed
    1. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. . Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011; 364:2187–2198. doi: 10.1056/NEJMoa1103510. - PubMed
    1. Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, et al. . Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 2017; 376:1321–1331. doi: 10.1056/NEJMoa1700456. - PubMed
    1. Thourani VH, Kodali S, Makkar RR, Herrmann HC, Williams M, Babaliaros V, et al. . Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet 2016; 387:2218–2225. doi: 10.1016/s0140-6736(16)30073-3. - PubMed