Author + information
- Received November 26, 2018
- Revision received February 11, 2019
- Accepted February 14, 2019
- Published online June 17, 2019.
- Tian-Yuan Xiong, MDa,b,∗,
- Yi-Jian Li, MDa,∗,
- Yuan Feng, MDa,
- Yan-Biao Liao, MDa,
- Zhen-Gang Zhao, MDa,
- Darren Mylotte, MB, MDc,
- Xin Wei, MDa,
- Yuan-Ning Xu, MDa,
- Yong Peng, MDa,
- Jia-Fu Wei, MDa,
- Ming-Xia Zheng, BScNa,
- Xuan Zhou, MDd,
- Wei Meng, MDe,
- Nicolo Piazza, MD, PhDb,∗∗ (, )@eclipsekuma and
- Mao Chen, MD, PhDa,∗ ()
- aDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- bDepartment of Medicine, Division of Cardiology, McGill University Health Centre, Montréal, Québec, Canada
- cDepartment of Cardiology, University Hospital, and National University of Ireland, Galway, Ireland
- dDepartment of Radiology, West China Hospital, Sichuan University, Chengdu, China
- eDepartment of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
- ↵∗Addresses for correspondence:
Dr. Mao Chen, Department of Cardiology, West China Hospital, Sichuan University, #37 Guo Xue Alley, Chengdu, 610041, PR China.
- ↵∗∗Dr. Nicolo Piazza, Division of Cardiology, Department of Medicine, McGill University Health Centre, The Royal Victoria Hospital, 1001 Boul. Décarie, Montréal, Québec H4A 3J1, Canada.
Objectives The authors sought to better understand the stent geometry of the Lotus valve after transcatheter aortic valve replacement (TAVR) and its potential implications for valve size selection.
Background The authors hypothesized that the greatest interference between the frame and aortic valvar complex occurs across the aortic valve leaflets.
Methods The authors retrospectively analyzed the multidetector computed tomography (MDCT) scans of 32 consecutive patients undergoing Lotus valve (Boston Scientific, Natick, Massachusetts) implantation. The prosthesis cross section was analyzed at 3-mm increments along its length. The plane where the frame had the smallest area was defined as the waist. The corresponding plane of the waist on pre-procedural MDCT was identified by surrounding structures such as calcium deposits, commissural fusion, and commissural gaps, and was referred to as the supra-annulus. The spline of the supra-annulus was circumscribed with reference to the post-implant stent geometry at the waist.
Results The waist was 5.8 ± 1.7 mm higher than the native annulus on post-procedural MDCT. The waist had a nearly 2-fold larger compression rate than the stent at the native annulus level (36.3 ± 10.4% vs. 18.9 ± 9.6%; p < 0.01), irrespective of valve morphologies. The supra-annulus was 5.9 ± 1.6 mm higher than the annulus on pre-procedural MDCT. Patients had an approximately 17% decrease in area from the annulus to the supra-annulus (18.3 ± 4.4% for bicuspid morphology and 16.0 ± 3.5% for tricuspid morphology).
Conclusions Major interference between the implanted prosthesis and anatomy occurred at a level above the annulus. The decrease in area from the annulus to supra-annulus may explain the feasibility of implanting a smaller valve than that suggested by traditional annular measurements.
↵∗ Drs. Xiong and Li contributed equally to this work.
This work was supported by the Science and Technology Innovative Research Groups Program of Sichuan province grant 2017TD0004; the “13th Five-Year” National Key Research and Development Program of China grants 2016YFC1102204 and 2017YFC1104204; and the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University. Dr. Xiong is supported by a scholarship given by the Chinese Scholarship Council. Drs. Feng and Chen have been consultants/proctors for Venus MedTech and MicroPort. Dr. Mylotte has been a consultant/proctor for Medtronic and MicroPort. Dr. Piazza has been a consultant/proctor for Medtronic and MicroPort; and is a cofounder of FluoroCT. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 26, 2018.
- Revision received February 11, 2019.
- Accepted February 14, 2019.
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