Skip to main content
SpringerLink
Log in

Characteristics of aorto-iliofemoral arterial tree according to aortic valve morphology in chinese patients considered for TAVR

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

To characterize the anatomy of aorto-iliofemoral arterial tree according to aortic valve phenotype by CT in patients referred for transcatheter aortic valve replacement (TAVR). We retrospectively enrolled 215 patients screened for TAVR who underwent CT. Dimensions, calcification, vascular tortuosity index score and other putative risk features of 13 different regions were evaluated for bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) morphology. The study consisted of 44% BAVs with younger age than TAVs. The dimensions of the annulus, sinus of Valsalva, ascending aorta and aortic arch were consistently larger in BAVs. The prevalence of calcification of aortic arch was significantly higher in TAVs even after adjustment for atherosclerotic risk factors. BAVs was associated with two-fold higher odds of having over I degree AA calcification (odds ratio 2.02; 95% CI 1.60–5.31; p < 0.001). The prevalence of severe iliac tortuosity was higher among BAVs (11.7 vs. 2.5%, p = 0.015). BAVs had a trend to more atheroma than TAVs in the abdominal aortic artery and iliofemoral artery. BAV anatomy is common in Chinese AS patients screened for TAVR. Aorto-iliofemoral pathology varies according to aortic valve phenotype, which may contribute to technical challenges in BAV vs. TAV anatomy and support the need for the integrated risk assessment for each valve phenotype.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Mack MJ, Leon MB, Smith CR et al (2015) 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 385:2477–2484

    Article  PubMed  Google Scholar 

  2. Philip F, Faza NN, Schoenhagen P et al (2015) Aortic annulus and root characteristics in severe aortic stenosis due to bicuspid aortic valve and tricuspid aortic valves: implications for transcatheter aortic valve therapies. Catheter Cardiovasc Interv 86:E88-98

    Article  PubMed  Google Scholar 

  3. Jilaihawi H, Chen M, Webb J et al (2016) A bicuspid aortic valve imaging classification for the TAVR era. JACC Cardiovasc Imaging 9:1145–1158

    Article  PubMed  Google Scholar 

  4. Perlman GY, Blanke P, Dvir D et al (2016) Bicuspid aortic valve stenosis: favorable early outcomes with a next-generation transcatheter heart valve in a multicenter study. JACC Cardiovasc Interv 9:817–824

    Article  PubMed  Google Scholar 

  5. Tamburino C, Capodanno D, Ramondo A et al (2011) Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation 123:299–308

    Article  PubMed  Google Scholar 

  6. Erbel R, Aboyans V, Boileau C et al (2014) 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 35:2873–2926

    Article  PubMed  Google Scholar 

  7. Jurencak T, Turek J, Kietselaer BL et al (2015) MDCT evaluation of aortic root and aortic valve prior to TAVI. What is the optimal imaging time point in the cardiac cycle? Eur Radiol 25:1975–1983

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dencker D, Taudorf M, Luk NH et al (2016) Frequency and effect of access-related vascular injury and subsequent vascular intervention after transcatheter aortic valve replacement. Am J Cardiol 118:1244–1250

    Article  PubMed  Google Scholar 

  9. Morris SA, Orbach DB, GevaT et al (2011) Increased vertebral artery tortuosity index is associated with adverse outcomes in children and young adults with connective tissue disorders. Circulation 124:388–396

    Article  PubMed  Google Scholar 

  10. Bapat VN, Attia RQ, Thomas M (2012) Distribution of calcium in the ascending aorta in patients undergoing transcatheter aortic valve implantation and its relevance to the transaortic approach. JACC Cardiovasc Interv 5:470–476

    Article  PubMed  Google Scholar 

  11. Wanhainen A, Themudo R, Ahlstrom H, Lind L, Johansson L (2008) Thoracic and abdominal aortic dimension in 70-year-old men and women–a population-based whole-body magnetic resonance imaging (MRI) study. J Vasc Surg 47:504–512

    Article  PubMed  Google Scholar 

  12. Gerhard-Herman MD, Gornik HL, Barrett C et al (2017) 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 135:e726–e779

    Article  PubMed  Google Scholar 

  13. Phan K, Wong S, Phan S, Ha H, Qian P, Yan TD (2015) Transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve stenosis–systematic review and meta-analysis. Heart Lung Circ 24:649–659

    Article  PubMed  Google Scholar 

  14. Biner S, Rafique AM, Ray I, Cuk O, Siegel RJ, Tolstrup K (2009) Aortopathy is prevalent in relatives of bicuspid aortic valve patients. J Am Coll Cardiol 53:2288–2295

    Article  PubMed  PubMed Central  Google Scholar 

  15. Fazel SS, Mallidi HR, Lee RS et al (2008) The aortopathy of bicuspid aortic valve disease has distinctive patterns and usually involves the transverse aortic arch. J Thorac Cardiovasc Surg 135:901–907

    Article  PubMed  Google Scholar 

  16. Cecconi M, Manfrin M, Moraca A et al (2005) Aortic dimensions in patients with bicuspid aortic valve without significant valve dysfunction. Am J Cardiol 95:292–294

    Article  PubMed  Google Scholar 

  17. Alegret JM, Calvo N, Ligero C et al (2010) Dilated aortic root is related to a global aortic dilating diathesis. J Vasc Surg 52:867–871

    Article  PubMed  Google Scholar 

  18. Foffa I, Ait Alì L, Panesi P et al (2013) Sequencing of NOTCH1, GATA5, TGFBR1 and TGFBR2 genes in familial cases of bicuspid aortic valve. BMC Med Genet 14:44

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Kim M, Shim CY, You SC et al (2017) Characteristics of carotid artery structure and mechanical function and their relationships with aortopathy in patients with bicuspid aortic valves. Front Physiol 28:622

    Article  Google Scholar 

  20. Kodali S, Thourani VH, White J et al (2016) Early clinical and echocardiographic outcomes after SAPIEN 3 transcatheter aortic valve replacement in inoperable, high-risk and intermediate-risk patients with aortic stenosis. Eur Heart J 37:2252–2262

    Article  PubMed  Google Scholar 

  21. Harbaoui B, Courand PY, Charles P et al (2015) Aortic calcifications present the next challenge after TAVR. J Am Coll Cardiol 65:1058–1060

    Article  PubMed  Google Scholar 

  22. Szeto WY, Augoustides JG, Desai ND et al (2011) Cerebral embolic exposure during transfemoral and transapical transcatheter aortic valve replacement. J Card Surg 26:348–354

    Article  PubMed  Google Scholar 

  23. Faggiano P, Frattini S, Zilioli V et al (2012) Prevalence of comorbidities and associated cardiac diseases in patients with valve aortic stenosis. Potential implications for the decision-making process. Int J Cardiol 159:94–99

    Article  PubMed  Google Scholar 

  24. Rodes-Cabau J, Webb JG, Cheung A et al (2010) Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 55:1080–1090

    Article  PubMed  Google Scholar 

  25. Fraccaro C, Buja G, Tarantini G et al (2011) Incidence, predictors, and outcome of conduction disorders after transcatheter self-expandable aortic valve implantation. Am J Cardiol 107:747–754

    Article  PubMed  Google Scholar 

  26. Bauer T, Linke A, Sievert H et al (2014) Comparison of the effectiveness of transcatheter aortic valve implantation in patients with stenotic bicuspid versus tricuspid aortic valves (from the German TAVI Registry). Am J Cardiol 113:518–521

    Article  PubMed  Google Scholar 

  27. Leroux-Berger M, Queguiner I, Maciel TT, Ho A, Relaix F, Kempf H (2011) Pathologic calcification of adult vascular smooth muscle cells differs on their crest or mesodermal embryonic origin. J Bone Miner Res 26:1543–1553

    Article  PubMed  CAS  Google Scholar 

  28. Latham RD, Westerhof N, Sipkema P, Rubal BJ, Reuderink P, Murgo JP (1985) Regional wave travel and reflections along the human aorta: a study with six simultaneous micromanometric pressures. Circulation 72:1257–1269

    Article  PubMed  CAS  Google Scholar 

  29. Folkersen L, Wagsater D, Paloschi V et al (2011) Unraveling divergent gene expression profiles in bicuspid and tricuspid aortic valve patients with thoracic aortic dilatation: the ASAP study. Mol Med 17:1365–1373

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Haunschild J, Schellinger IN, von Salisch S et al (2017) Granular media calcinosis in the aortic walls of patients with bicuspid and tricuspid aortic valves. Ann Thorac Surg 103:1178–1185

    Article  PubMed  Google Scholar 

  31. Bissell MM, Hess AT, Biasiolli L et al (2013) Aortic dilation in bicuspid aortic valve disease: flow pattern is a major contributor and differs with valve fusion type. Circ Cardiovasc Imaging 6:499–507

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the staff members of the Imaging Department for their invaluable contribution.

Funding

This study has received funding by grants from Pecking Union Medical College Student Innovation Fund (Project No.: 2016-1002-01-05, Beijing, China), YW.

Author information

Authors and Affiliations

  1. Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

    Yuan Wang, Guanyuan Song, Moyang Wang, Guannan Niu, Zheng Zhou & Yongjian Wu

  2. Department of Cardiology and Cardiothoracic Surgery, NYU Langone Medical Center, New York, NY, USA

    Hasan Jilaihawi

  3. Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China

    Bin Lv

  4. Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China

    Hao Wang

Authors
  1. Yuan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hasan Jilaihawi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guanyuan Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Moyang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bin Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hao Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guannan Niu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zheng Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yongjian Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yongjian Wu.

Ethics declarations

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 15 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Y., Jilaihawi, H., Song, G. et al. Characteristics of aorto-iliofemoral arterial tree according to aortic valve morphology in chinese patients considered for TAVR. Int J Cardiovasc Imaging 34, 1135–1142 (2018). https://doi.org/10.1007/s10554-018-1310-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-018-1310-8

Keywords

Search

Navigation