Commissural Alignment of Bioprosthetic Aortic Valve and Native Aortic Valve Following Surgical and Transcatheter Aortic Valve Replacement and its Impact on Valvular Function and Coronary Filling

Andreas Fuchs; Klaus F. Kofoed; Sung Han Yoon; Yannick Schaffner; Gintautas Bieliauskas; Hans Gustav Thyregod; Raj Makkar; Lars Søndergaard; Ole De Backer; Vinayak Bapat

doi:10.1016/j.jcin.2018.05.043

Commissural Alignment of Bioprosthetic Aortic Valve and Native Aortic Valve Following Surgical and Transcatheter Aortic Valve Replacement and its Impact on Valvular Function and Coronary Filling

Andreas Fuchs, Klaus F. Kofoed, Sung Han Yoon, Yannick Schaffner, Gintautas Bieliauskas, Hans Gustav Thyregod, Raj Makkar, Lars Søndergaard, Ole De Backer, Vinayak Bapat^*

^*Corresponding author for this work

Department of Clinical Medicine

25 Citations (Scopus)

Abstract

Objectives: The aim of this study was to assess the commissural alignment between bioprosthetic and native aortic valve leaflets following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) and to investigate its impact on valvular function and coronary filling. Background: Expansion and geometry have been shown to affect leaflets of implanted transcatheter aortic bioprosthesis, but commissural alignment has not been studied. Methods: Pre- and post-procedural multidetector computed tomography (MDCT) of 28 SAVR patients and 212 TAVR patients were analyzed. Commissural alignment between the bioprosthetic (post) and native (pre) aortic valves was categorized as aligned (0° to 15° angle deviation) or as mild (15° to 30°), moderate (30° to 45°), or severe (45° to 60°) commissural misalignment (CMA). Results: With SAVR, 27 of 28 cases (96%) were aligned and 1 had mild CMA. For all types of transcatheter heart valves (THVs), there was random valve implantation with regard to commissural alignment: 22% of THVs were aligned, 25% had mild CMA, 22% had moderate CMA, and 31% had severe CMA. The degree of commissural alignment was not associated with a difference in transvalvular gradient, paravalvular aortic regurgitation, or simulated coronary filling. However, there was a significantly higher rate of mild central aortic regurgitation in those THVs with moderate or greater CMA compared with those THV with mild or less CMA (7.8% vs. 1.1%; p = 0.03). Conclusions: Commissural alignment is excellent in case of SAVR but random in case of TAVR. There is no association between CMA and transvalvular gradient or coronary filling; however, there is a significantly higher rate of mild central aortic regurgitation in case of moderate or greater CMA.

Original language	English
Journal	JACC: Cardiovascular Interventions
Volume	11
Issue number	17
Pages (from-to)	1733-1743
Number of pages	11
ISSN	1936-8798
DOIs	https://doi.org/10.1016/j.jcin.2018.05.043
Publication status	Published - 2018

Keywords

aortic stenosis
aortic valve replacement
computed tomography
surgical
transcatheter

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10.1016/j.jcin.2018.05.043

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Fuchs, A., Kofoed, K. F., Yoon, S. H., Schaffner, Y., Bieliauskas, G., Thyregod, H. G., Makkar, R., Søndergaard, L., De Backer, O., & Bapat, V. (2018). Commissural Alignment of Bioprosthetic Aortic Valve and Native Aortic Valve Following Surgical and Transcatheter Aortic Valve Replacement and its Impact on Valvular Function and Coronary Filling. JACC: Cardiovascular Interventions, 11(17), 1733-1743. https://doi.org/10.1016/j.jcin.2018.05.043

Commissural Alignment of Bioprosthetic Aortic Valve and Native Aortic Valve Following Surgical and Transcatheter Aortic Valve Replacement and its Impact on Valvular Function and Coronary Filling. / Fuchs, Andreas; Kofoed, Klaus F.; Yoon, Sung Han et al.

In: JACC: Cardiovascular Interventions, Vol. 11, No. 17, 2018, p. 1733-1743.

Research output: Contribution to journal › Journal article › Research › peer-review

Fuchs, A, Kofoed, KF, Yoon, SH, Schaffner, Y, Bieliauskas, G, Thyregod, HG, Makkar, R, Søndergaard, L, De Backer, O & Bapat, V 2018, 'Commissural Alignment of Bioprosthetic Aortic Valve and Native Aortic Valve Following Surgical and Transcatheter Aortic Valve Replacement and its Impact on Valvular Function and Coronary Filling', JACC: Cardiovascular Interventions, vol. 11, no. 17, pp. 1733-1743. https://doi.org/10.1016/j.jcin.2018.05.043

@article{1d1092b64ba742f4a313e9113a9b19c5,

title = "Commissural Alignment of Bioprosthetic Aortic Valve and Native Aortic Valve Following Surgical and Transcatheter Aortic Valve Replacement and its Impact on Valvular Function and Coronary Filling",

abstract = "Objectives: The aim of this study was to assess the commissural alignment between bioprosthetic and native aortic valve leaflets following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) and to investigate its impact on valvular function and coronary filling. Background: Expansion and geometry have been shown to affect leaflets of implanted transcatheter aortic bioprosthesis, but commissural alignment has not been studied. Methods: Pre- and post-procedural multidetector computed tomography (MDCT) of 28 SAVR patients and 212 TAVR patients were analyzed. Commissural alignment between the bioprosthetic (post) and native (pre) aortic valves was categorized as aligned (0° to 15° angle deviation) or as mild (15° to 30°), moderate (30° to 45°), or severe (45° to 60°) commissural misalignment (CMA). Results: With SAVR, 27 of 28 cases (96%) were aligned and 1 had mild CMA. For all types of transcatheter heart valves (THVs), there was random valve implantation with regard to commissural alignment: 22% of THVs were aligned, 25% had mild CMA, 22% had moderate CMA, and 31% had severe CMA. The degree of commissural alignment was not associated with a difference in transvalvular gradient, paravalvular aortic regurgitation, or simulated coronary filling. However, there was a significantly higher rate of mild central aortic regurgitation in those THVs with moderate or greater CMA compared with those THV with mild or less CMA (7.8% vs. 1.1%; p = 0.03). Conclusions: Commissural alignment is excellent in case of SAVR but random in case of TAVR. There is no association between CMA and transvalvular gradient or coronary filling; however, there is a significantly higher rate of mild central aortic regurgitation in case of moderate or greater CMA.",

keywords = "aortic stenosis, aortic valve replacement, computed tomography, surgical, transcatheter",

author = "Andreas Fuchs and Kofoed, {Klaus F.} and Yoon, {Sung Han} and Yannick Schaffner and Gintautas Bieliauskas and Thyregod, {Hans Gustav} and Raj Makkar and Lars S{\o}ndergaard and {De Backer}, Ole and Vinayak Bapat",

year = "2018",

doi = "10.1016/j.jcin.2018.05.043",

language = "English",

volume = "11",

pages = "1733--1743",

journal = "J A C C: Cardiovascular Interventions",

issn = "1936-8798",

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number = "17",

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TY - JOUR

T1 - Commissural Alignment of Bioprosthetic Aortic Valve and Native Aortic Valve Following Surgical and Transcatheter Aortic Valve Replacement and its Impact on Valvular Function and Coronary Filling

AU - Fuchs, Andreas

AU - Kofoed, Klaus F.

AU - Yoon, Sung Han

AU - Schaffner, Yannick

AU - Bieliauskas, Gintautas

AU - Thyregod, Hans Gustav

AU - Makkar, Raj

AU - Søndergaard, Lars

AU - De Backer, Ole

AU - Bapat, Vinayak

PY - 2018

Y1 - 2018

N2 - Objectives: The aim of this study was to assess the commissural alignment between bioprosthetic and native aortic valve leaflets following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) and to investigate its impact on valvular function and coronary filling. Background: Expansion and geometry have been shown to affect leaflets of implanted transcatheter aortic bioprosthesis, but commissural alignment has not been studied. Methods: Pre- and post-procedural multidetector computed tomography (MDCT) of 28 SAVR patients and 212 TAVR patients were analyzed. Commissural alignment between the bioprosthetic (post) and native (pre) aortic valves was categorized as aligned (0° to 15° angle deviation) or as mild (15° to 30°), moderate (30° to 45°), or severe (45° to 60°) commissural misalignment (CMA). Results: With SAVR, 27 of 28 cases (96%) were aligned and 1 had mild CMA. For all types of transcatheter heart valves (THVs), there was random valve implantation with regard to commissural alignment: 22% of THVs were aligned, 25% had mild CMA, 22% had moderate CMA, and 31% had severe CMA. The degree of commissural alignment was not associated with a difference in transvalvular gradient, paravalvular aortic regurgitation, or simulated coronary filling. However, there was a significantly higher rate of mild central aortic regurgitation in those THVs with moderate or greater CMA compared with those THV with mild or less CMA (7.8% vs. 1.1%; p = 0.03). Conclusions: Commissural alignment is excellent in case of SAVR but random in case of TAVR. There is no association between CMA and transvalvular gradient or coronary filling; however, there is a significantly higher rate of mild central aortic regurgitation in case of moderate or greater CMA.

AB - Objectives: The aim of this study was to assess the commissural alignment between bioprosthetic and native aortic valve leaflets following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) and to investigate its impact on valvular function and coronary filling. Background: Expansion and geometry have been shown to affect leaflets of implanted transcatheter aortic bioprosthesis, but commissural alignment has not been studied. Methods: Pre- and post-procedural multidetector computed tomography (MDCT) of 28 SAVR patients and 212 TAVR patients were analyzed. Commissural alignment between the bioprosthetic (post) and native (pre) aortic valves was categorized as aligned (0° to 15° angle deviation) or as mild (15° to 30°), moderate (30° to 45°), or severe (45° to 60°) commissural misalignment (CMA). Results: With SAVR, 27 of 28 cases (96%) were aligned and 1 had mild CMA. For all types of transcatheter heart valves (THVs), there was random valve implantation with regard to commissural alignment: 22% of THVs were aligned, 25% had mild CMA, 22% had moderate CMA, and 31% had severe CMA. The degree of commissural alignment was not associated with a difference in transvalvular gradient, paravalvular aortic regurgitation, or simulated coronary filling. However, there was a significantly higher rate of mild central aortic regurgitation in those THVs with moderate or greater CMA compared with those THV with mild or less CMA (7.8% vs. 1.1%; p = 0.03). Conclusions: Commissural alignment is excellent in case of SAVR but random in case of TAVR. There is no association between CMA and transvalvular gradient or coronary filling; however, there is a significantly higher rate of mild central aortic regurgitation in case of moderate or greater CMA.

KW - aortic stenosis

KW - aortic valve replacement

KW - computed tomography

KW - surgical

KW - transcatheter

U2 - 10.1016/j.jcin.2018.05.043

DO - 10.1016/j.jcin.2018.05.043

M3 - Journal article

C2 - 30121280

AN - SCOPUS:85052203266

SN - 1936-8798

VL - 11

SP - 1733

EP - 1743

JO - J A C C: Cardiovascular Interventions

JF - J A C C: Cardiovascular Interventions

IS - 17

ER -

Commissural Alignment of Bioprosthetic Aortic Valve and Native Aortic Valve Following Surgical and Transcatheter Aortic Valve Replacement and its Impact on Valvular Function and Coronary Filling

Abstract

Keywords

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