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Anatomical features of the aortic root in aortic stenosis and a novel approach for transcatheter aortic valve implantation

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Abstract

A narrow and calcified sinotubular junction (STJ) represents a risk for ascending aortic dissection after balloon-expandable transcatheter aortic valve implantation (TAVI). The aim of this study was to assess computed tomography (CT)-based aortic root morphology in patients with aortic stenosis (AS), and to evaluate the feasibility of a two-step inflation technique that we devised for TAVI using the SAPIEN 3 in patients with a narrow and calcified STJ. We retrospectively analyzed the STJ diameter (STJD) as well the as aortic annulus diameter (AAD) and STJ calcification using CT imaging in 412 patients undergoing TAVI. We defined a “narrow STJ” as a minimum STJD that was smaller than the diameter corresponding to a 10% oversized annulus area, and a “calcified STJ” as an STJ calcification angle > 90°. A “narrow and calcified STJ” was identified in 54 patients (13.1%) of patients. Among them, we performed TAVI using the two-step inflation technique with SAPIEN 3 in 20 patients and compared with 11 patients that underwent the conventional inflation procedure. Two-step inflation was successfully performed without ascending aortic dissection in all 20 patients. The effective orifice area index at discharge in these 20 patients was similar to that in 11 patients who underwent the conventional inflation procedure for a “narrow and calcified STJ” [1.40 (1.20–1.51) vs. 1.33 (1.18–1.41) cm2/m2, p = 0.23]. Although further assessment is required, the two-step inflation technique with the SAPIEN 3 is feasible for a narrow and calcified STJ.

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Authors and Affiliations

  1. Department of Cardiology, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba, Sendai, Miyagi, 980-0873, Japan

    Norio Tada, Takashi Matsumoto, Mie Sakurai, Yukiko Mizutani, Yusuke Enta, Kazunori Ishii & Tatsushi Ootomo

  2. Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan

    Norio Tada, Teruo Inoue, Takashi Matsumoto, Masashi Sakuma & Shigeru Toyoda

  3. Department of Anesthesiology, Sendai Kousei Hospital, Sendai, Japan

    Hiroshi Inoue

  4. Department of Biostatistics and Epidemiology, Yokohama City University, Yokohama, Japan

    Masataka Taguri

  5. Department of Cardiovascular Surgery, Sendai Kousei Hospital, Sendai, Japan

    Masaki Hata

Authors
  1. Norio Tada
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  2. Teruo Inoue
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  3. Takashi Matsumoto
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  4. Mie Sakurai
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  5. Yukiko Mizutani
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  6. Yusuke Enta
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  7. Kazunori Ishii
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  8. Hiroshi Inoue
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  9. Masataka Taguri
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  10. Masaki Hata
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Correspondence to Norio Tada.

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Conflict of interest

Norio Tada is a clinical proctor for Edwards Lifesciences. All the other authors have no conflict of interest to disclose.

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Tada, N., Inoue, T., Matsumoto, T. et al. Anatomical features of the aortic root in aortic stenosis and a novel approach for transcatheter aortic valve implantation. Heart Vessels 33, 908–917 (2018). https://doi.org/10.1007/s00380-018-1130-8

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  • DOI: https://doi.org/10.1007/s00380-018-1130-8

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