Author + information
- Received March 12, 2018
- Revision received May 22, 2018
- Accepted May 29, 2018
- Published online September 3, 2018.
- Andreas Fuchs, MD, PhDa,b,
- Klaus F. Kofoed, MD, PhD, DMSca,b,
- Sung-Han Yoon, MDc,
- Yannick Schaffnerd,
- Gintautas Bieliauskas, MDa,
- Hans Gustav Thyregod, MD, PhDa,
- Raj Makkar, MD, PhDc,
- Lars Søndergaard, MD, DMSca,
- Ole De Backer, MD, PhDa and
- Vinayak Bapat, MDe,∗ ()
- aThe Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- bDepartment of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- cHeart Institute for Interventional Technologies, Cedars-Sinai, Los Angeles, California
- dFEops, Ghent, Belgium
- eDepartment of Cardiovascular Surgery, Columbia University Medical Center, New York, New York
- ↵∗Address for correspondence:
Dr. Vinayak Bapat, Department of Cardiovascular Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, MHB 7GN-435, New York, New York 10032.
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.
Dr. De Backer has been a consultant for Abbott. Prof. Dr. Søndergaard has been a consultant for and received institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr. Bieliauskas has been a consultant for Abbott, Edwards Lifesciences, and Medtronic; and received an institutional research grant from Boston Scientific. Dr. Bapat has been a consultant for Abbott, Edwards Lifesciences, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 12, 2018.
- Revision received May 22, 2018.
- Accepted May 29, 2018.