Supra-annular sizing of transcatheter aortic valve prostheses in raphe-type bicuspid aortic valve disease: the LIRA method

• Published in: International journal of cardiology 2020-10, Vol.317, p.144-151
• Main Authors: Iannopollo, Gianmarco, Romano, Vittorio, Buzzatti, Nicola, Ancona, Marco, Ferri, Luca, Russo, Filippo, Bellini, Barbara, Granada, Juan F., Chieffo, Alaide, Montorfano, Matteo
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic stenosis; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Disease; Aortic Valve Stenosis - surgery; Bicuspid aortic valve; Female; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - surgery; Heart Valve Prosthesis; Humans; Male; MSCT; Multidetector Computed Tomography; Prosthesis Design; TAVI; Transcatheter Aortic Valve Replacement; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2020.05.076

Recent evidence shows that THV prostheses anchoring occurs at the raphe-level, known as LIRA plane, in raphe-type bicuspid aortic valve (BAV) disease. The purpose of this study was to evaluate the application of a novel supra-annular sizing method, known as Level of Implantation at the RAphe (LIRA) method, to optimize transcatheter heart valve (THV) prosthesis sizing in raphe-type BAV disease. The LIRA method was applied to all consecutive patients with raphe-type BAV disease between November 2018 to January 2020 in our centre. THV prostheses were sized on the basis of baseline CT scan perimeters at the LIRA plane and at the virtual basal ring. In case of discrepancy between the two plane measurements, the plane with the smallest perimeter was considered the reference for prosthesis sizing. Post-procedural device success, defined according to Valve Academic Research Consortium–2 (VARC-2) criteria, was evaluated in the overall cohort. 20 patients (mean patient age 81 ± 5.4 years, 70% males) were identified as having a raphe-type BAV disease at pre-procedural CT scans and were implanted with different types of THV prostheses. The LIRA plane method appeared to be highly successful (100% VARC-2 device success) with no procedural mortality, no valve migration, no moderate-severe paravalvular leak and low transprosthetic gradient (residual mean gradient of 8.2 ± 2.9 mm Hg). Supra-annular sizing according to the LIRA method appeared to be safe with a high device success. The application of the LIRA method might optimize THV prosthesis sizing in patients with raphe-type BAV disease. •THV prostheses anchoring occurs at the LIRA plane in raphe-type BAV disease.•Supra-annular prosthesis sizing is not standardized in BAV disease.•The LIRA sizing method appeared to be safe with a high device success.•The LIRA method might optimize prosthesis sizing in raphe-type BAV disease.