Results:
Table 1 displays baseline patient characteristics. Of the 48 patients, 64% (n=31) presented with AI and 36% (n=17) presented with AS. Patients with AI were younger (59yrs vs 68.7yrs, P<0.01) than patients with AS. Prevalence of bicuspid valves was 74% (n=23) in patients with AI and 53% (n=9) in patients with AS (P= 0.11). Patients with AI had a larger annulus (annulus area; 554.77mm2± 123.2 vs 474.18mm2 ± 135.41, P=0.049) and STJ size (average STJ diameter; 31.49mm ± 3.67 vs 28.49mm ± 3.28, P=<0.01) than those with AS. Of the 31 patients with bicuspid morphology, 9 (29%) were Sieverts Type 0 and the rest were Sieverts Type 1 (71%) based on MDCT evaluation.
The predominant valve used was Carpentier Edwards Magna Ease (75%) while a Medtronic Mosaic valve was used 15% and Edwards Perimount 10%. Among all AI patients, preoperative measurements based on MDCT predicted that no patients would be at high risk for coronary obstruction with ViV TAVR. Among patients with AS, the majority of patients (82%) were not at high risk for ViV TAVR. Among the 18% of patients (n=3) with high risk anatomy, the mechanism was sinus sequestration in one patient and leaflet obstruction (VTC <4mm) in two patients. All patients with high risk anatomy had tricuspid AS. Of the tricuspid AS patients, 38% (n=3) were high risk for ViV TAVR (very low numbers – only 8 pts - limitation). In contrary, there were no high risk patients with bicuspid AS. (FIGURE 4)
In patients with AI, MDCT properly predicted valve size in 71% of patients. The other 29% had a smaller valve implanted (MDCT overestimated the measurements). In patients with AS, MDCT properly predicted valve size in 94% of patients (all but one patient). There was only one patient in which MDCT underestimated the measurement (a patient with tricuspid AS, in which the annular average diameter was 23.5mm, and a 25mm valve was implanted). Table 2 displays how often the valve size was correctly predicted based on MDCT measurements. In patients with AI there was strong correlation between actual valve size implanted and annulus average diameter (R2=0.72, P<0.01), area (R2=0.73, P<0.01) and perimeter (R2=0.70, P<0.01) on MDCT. (FIGURE 5) In patients with AS, there was also a strong correlation between actual valve size implanted and annulus average diameter (R2=0.90, P<0.01), area (R2=0.85, P<0.01) and perimeter (R2=0.90, P<0.01). (FIGURE 6)