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Comparative Study
. 2025 Apr;105(5):1032-1041.
doi: 10.1002/ccd.31408. Epub 2025 Jan 22.

Elastic Recoil and Deployment Asymmetry of the Transcatheter Heart Valve in Bicuspid Versus Tricuspid Anatomy

Odette Iskandar  1 , Habib Layoun  1 , Shivabalan Kathavarayan Ramu  1 , Judah Rajendran Ravi Raja Malar Vannan  1 , Elian Abou Asala  1 , Jaideep Singh Bhalla  1 , Elizabeth Ghandakly  1 , Besir Besir  1 , James Yun  1 , Grant Reed  1 , Rishi Puri  1 , Serge Harb  1 , Amar Krishnaswamy  1 , Samir R Kapadia  1
Affiliations
Comparative Study

Elastic Recoil and Deployment Asymmetry of the Transcatheter Heart Valve in Bicuspid Versus Tricuspid Anatomy

Odette Iskandar et al. Catheter Cardiovasc Interv. 2025 Apr.

Abstract

Background: Data supporting the use of transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve (BAV) is limited compared to tricuspid aortic valve (TAV) anatomy, as the BAV anatomy poses unique challenges to prosthesis expansion and symmetric deployment.

Aims: We aim to compare the acute recoil and asymmetry of the SAPIEN-3 valve between BAV and TAV anatomies and their impact on procedural outcomes.

Methods: We conducted a single-center study of patients who underwent TAVR with the SAPIEN-3 valve. We measured acute recoil, deployment asymmetry, and length asymmetry from intraprocedural angiogram before and after postdilation, as well as before and after predilation. Hemodynamic and procedural outcomes were studied.

Results: Among 946 patients, 9% had BAV. In the RAO view, BAV patients had significantly higher absolute and relative acute recoil across all diameters, while in the LAO view, only central diameter relative recoil was significantly higher (p < 0.001). Deployment asymmetry was more common in BAV patients with an OR of 1.88 (CI 1.19, 2.96; p = 0.01). Predilation reduced both length and deployment asymmetry in RAO and LAO views for TAV and BAV patients (p < 0.001). Postdilation significantly reduced acute valve recoil in both groups (p = 0.002 and p = 0.032). Hemodynamic outcomes were comparable between TAV and BAV patients, and there were no significant associations between deployment or length asymmetry and procedural outcomes.

Conclusions: Acute recoil, deployment asymmetry, and length asymmetry are common in BAV patients but do not affect short-term clinical outcomes or hemodynamics.

Keywords: acute elastic recoil; deployment asymmetry; length asymmetry; transcatheter aortic valve replacement.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Measurements taken in angiograms depicting how the measurements are made. Stent diameter measurements (upper level—a, mid‐level—b, lower level—c) of SAPIEN 3 on angiography at full balloon expansion (A) and immediately after balloon deflation (B). (a − a1) = Absolute Recoil of THV at Outflow; (b − b1) = Absolute Recoil of THV at Waist; (c − c1) = Absolute Recoil of THV at Inflow; ((a − a1)/a) × 100 = Relative Recoil of THV at Outflow; ((b − b1)/b) × 100 = Relative Recoil of THV at Waist; ((c − c1)/c) × 100 = Relative Recoil of THV at Inflow. (C) Length of the SAPIEN‐3 valve on either side measured en face. (D) Horizontal distance between the outer border of the stent on either side to the outer border of the sinus that is filled during contrast injection is measured to give the deployment asymmetry. LAO = Left anterior oblique, RAO = Right anterior oblique, THV = Transcatheter heart valve. [Color figure can be viewed at wileyonlinelibrary.com]
Central Illustration 1
Central Illustration 1
Acute valve recoil, deployment asymmetry and length asymmetry of the TAVR valve in bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV).
See this image and copyright information in PMC

References

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