Author + information
- Received June 8, 2012
- Revision received August 24, 2012
- Accepted September 6, 2012
- Published online January 1, 2013.
- Lutz Buellesfeld, MD⁎,⁎ (, )
- Stefan Stortecky, MD⁎,
- Bindu Kalesan, PhD†,
- Steffen Gloekler, MD⁎,
- Ahmed A. Khattab, MD⁎,
- Fabian Nietlispach, MD⁎,
- Valentina Delfine, MD⁎,
- Christoph Huber, MD‡,
- Balthasar Eberle, MD§,
- Bernhard Meier, MD⁎,
- Peter Wenaweser, MD⁎ and
- Stephan Windecker, MD⁎,†
- ↵⁎Reprint requests and correspondence
: Dr. Lutz Buellesfeld, Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse, 3010 Bern, Switzerland
Objectives The aim of this study was to characterize aortic root dimensions of patients with aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR) and to evaluate sex differences.
Background The advent of TAVR makes a precise delineation of the aortic root anatomy mandatory and requires a profound anatomic understanding.
Methods Patients planned to undergo TAVR underwent screening imaging with use of a 64-slice or dual-source electrocardiogram-gated contrast-enhanced computed tomography. Anatomic dimensions were assessed at the level of the left ventricular outflow tract (LVOT), annulus, sinus of Valsalva, and ascending aorta.
Results The study population comprised 80 men and 97 women (age: 82 ± 6 years) with symptomatic severe aortic valve stenosis. Multislice computed tomography aortic root assessment revealed larger annular and LVOT dimensions in men than women (area annulus: 483.1 ± 75.6 mm2 vs. 386.9 ± 58.5 mm2, p = 0.0002; area LVOT: 478.2 ± 131.0 mm2 vs. 374.0 ± 94.2 mm2, p = 0.0024), whereas dimensions of the ascending aorta were comparable. Both LVOT and annulus were predominantly oval without sex differences, with a higher mean ellipticity index for the LVOT compared with the annulus (1.49 ± 0.2 vs. 1.29 ± 0.1); the ascending aorta was primarily circular (1.07 ± 0.1). Although similar in mean surface area, an area mismatch of annulus and LVOT of more than 10%, 20%, and 40% was detected in 42, 9, and 2 patients, respectively. The mean distance from annulus to the left coronary ostium was smaller than the mean distance of the right coronary ostium (14.4 ± 3.6 mm vs. 16.7 ± 3.6 mm), and distances were lower among women than men.
Conclusions The aortic root has specific anatomic characteristics, which affect device design, selection, and clinical outcome in patients undergoing TAVR. Female sex is associated with smaller annular and LVOT but not aortic dimensions. The degree of ellipticity as well as a significant mismatch between annular and LVOT dimensions in selected patients deserve careful evaluation.
Dr. Buellesfeld is a consultant and proctor for Medtronic. Dr. Khattab has received speaker honoraria and proctor fees from Medtronic CoreValve and Edwards Lifesciences. Dr. Huber has received speaker honoraria and proctor fees from Edwards Lifesciences. Dr. Meier has received research grants from Medtronic and Abbott. Dr. Wenaweser is a proctor and receives honoraria from Medtronic CoreValve and Edwards Lifesciences. Dr. Windecker has received lecture and consultant fees from Edwards Lifesciences and Medtronic CoreValve. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Buellesfeld and Stortecky contributed equally to this work. The Guest Editor for this paper was Peter Block, MD.
- Received June 8, 2012.
- Revision received August 24, 2012.
- Accepted September 6, 2012.
- American College of Cardiology Foundation