TCT-510 Multislice computed tomography imaging of Sapien 3 transcatheter heart valve implantation in different bicuspid aortic valve anatomies

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016

CONCLUSION BAV patients have larger LVOT and aortic root measurements than TAV, including a more circular shaped annulus. Aside from this, the AA grows disproportionately bigger than other structures in BAV. These differences may need to be considered when planning for TAVR in BAV patients. CATEGORIES IMAGING: Non-Invasive

B205

post-TAVI MSCT measurement Inflow

TAV (n[120)

B-BAV (n[18)

T-BAV (n[11)

p

4.2
2.8

5.1
3.4

3.7
2.4

0.360

106.6
6.3

106.1
5.0

104.8
5.0

0.624

3.1
1.7

0.022

99.1
7.1

0.124

4.1
3.4

0.001

109.9
8.2

0.863

3.6
1.5

<0.001

104.6
6.3

0.478

excentricity index, % Inflow expansion ratio, %

TCT-510 Multislice computed tomography imaging of Sapien 3 transcatheter heart valve implantation in different bicuspid aortic valve anatomies Hiroyuki Kawamori,1 Yigal Abramowitz,2 Tarun Chakravarty,3 Yoshio Maeno,4 YOSHIO KAZUNO,5 Nobuyuki Takahashi,6 Mohammad Kashif,7 Geeteshwar Mangat,8 Wen Cheng,9 Raj Makkar,10 Hasan Jilaihawi11 1 Cedars-Sinai Heart Institute, Los Angeles, California, United States; 2 Cedars-Sinai Medical Center, Los Angeles, California, United States; 3 Cedars Sinai Medical Center, Los Angeles, California, United States; 4 Cedars-Sinai medeical center, Los Angeles, California, United States; 5 Cedars-Sinai Medical Center/Heart institute, Los Angeles, California, United States; 6Cedars Sinai Medical Center, Los Angeles, California, United States; 7Cedars-Sinai Heart Institute; 8Cedars-Sinai Heart Institute; 9Los Angeles, California, United States; 10Cedars-Sinai Medical Center, Los Angeles, California, United States; 11Cedars-Sinai Medical Center, Los Angeles, California, United States BACKGROUND Limited data exist about TAVI in patients with severe bicuspid aortic valve (BAV) disease. METHODS We included consecutive patients from the RESOLVE registry (NCT02318342) that had a contrast CT before and after TAVI and had Sapien 3 implantation. We classified this study population into three valve types as follows: (i) tricuspid aortic valve (TAV), (ii) BAV with tri-commissural anatomy (T-BAV, also known as functional/acquired), and (iii) bicuspid valve with bi-commissural anatomy (B-BAV, also known as congenital).

Mid excentricity

4.0
3.1

5.5
3.8**

index, % Mid expansion

98.8
8.0

94.7
5.4

ratio, % Outflow

3.3
2.5

5.9
3.6*

excentricity index, % Outflow

110.1
5.8

109.2
5.0

expansion ratio, % Mean

3.8
2.0

6.1
3.2**

excentricity index, % Mean expansion

105.2
6.0

103.4
4.1

ratio, % * <0.05 vs. TAV, ** <0.05 vs. TAV and T-BAV

CONCLUSION B-BAV patients have larger annulus size, aorta size and higher leaflet calcium volume compared to TAV patients. Eccentricy indexes of Sapien 3 THV in B-BAV patients were higher compared to TAV patients, but expansion ratio of this valve was not different between all three groups. TAVI with Sapien 3 in BAV patients results in a feasible THV stent-frame geometry regardless of BAV anatomy. Nonetheless, we found higher rates of periprocedural CVA and new pacemaker implantation in B-BAV patients. CATEGORIES STRUCTURAL: Valvular Disease: Aortic

TCT-511 Feasibility of MRI measures for aortic annulus assessment pre TAVR Vicente Alcalde-Martinez,1 Miriam Jimenez,2 Manuel Lopez Perez,3 Gerardo Moreno-Terribas,4 juan caballero-borrego,5 Joaquin Sanchez Gila,6 Eduardo Molina Navarro7 1 The Department of Cardiology, Kobe University Hospital., Granada, Spain; 2Complejo Hospitalario Universitario de Granada; 3Hospital Virgen de las Nieves, Granada, Spain; 4Servicio Andaluz de Salud, Granada, Spain; 5Complejo Hospitalario Universitario de Granada, Granada, Spain; 6Unknown, Granada, Spain; 7Unknown, Granada, Spain BACKGROUND The gold standard for aortic annulus assessment pre implantation of TAVR is the CT study, due to its high spatial resolution and noninvasive method. The improvements on the MRI offer a new radiation-free technique that must be validate for assessing the aortic annulus.

RESULTS A total of 149 patients had Sapien 3 implantation. Native valve type was TAV in 120 patients, B-BAV in 18 patients and T-BAV in 11 patients. B-BAV patients, in comparison to TAV patients, had larger annulus area (547.9
106.5 mm 2 vs 481.4
92.6 mm2; p<0.05), aorta dimension (35.7
4.1 mm vs. 33.6
3.1 mm; p<0.05) and leaflet calcium volume (850-HU threshold) (508.5
385.2 mm3 vs 229.3
195.6 mm3; p<0.05). The transcatheter heart valve (THV) stent-frame at mid-level and outflow-level eccentricity indexes in BBAV patients were higher compared to TAV patients. Valve expansion ratio at each level was not different between three groups. Periprocedural cerebrovascular (CVA) event and new permanent pacemaker implantation in B-BAV patients were higher compared to TAV patients (CVA: 0.84% vs 11.1%; p¼0.045, new pacemaker: 7.5% vs 33.3%; p¼0.011).

METHODS This is an observational study where a total of 15 consecutive patients were included. They were previously accepted for TAVR by our heart team. Cardiac CT and Cardiac MRI were performed to all of them using a 64 multidetectors CT and a 1.5 Tesla MRI. A cardiologist and a radiologist (independent and blind) measured diameter, perimeter and area of the aortic annulus in both CT and MRI; following general recommendations for cardiac chamber quantification. Three different statistical analysis were made using the correlation coefficient of Pearson (diameter, perimeter and area). The right valve size was selected using the measures obtained on CT and following the MedtronicÒ official recommendations. Corevalve Ò and Corevalve Evolut RÒ by MedtronicÒ were the two models implanted in these patients. RESULTS The mean annulus diameter measured on CT was 22.9 mm (minimum of 19.5 mm and maximum of 25 mm), while on MRI mean annulus diameter was 22.9 mm (minimum of 19.1 mm and maximum of 25.4 mm). The correlation coefficient of Pearson was R¼0.85 p<0.01 which means that there is a good correlation between both measures. Regarding the annulus perimeter, the mean measure on CT was 74.93 mm (minimum of 57 mm and maximum