Computed tomography characteristics of the aortic valve and the geometry of SAPIEN 3 transcatheter heart valve in patients with bicuspid aortic valve disease

Hiroyuki Kawamori, Sung Han Yoon, Tarun Chakravarty, Yoshio Maeno, Mohammad Kashif, Sharjeel Israr, Yigal Abramowitz, Geeteshwar Mangat, Masaki Miyasaka, Tanya Rami, Yoshio Kazuno, Nobuyuki Takahashi, Hasan Jilaihawi, Mamoo Nakamura, Wen Cheng, John Friedman, Daniel Berman, Rahul Sharma, Raj R. Makkar

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Aims We assessed the geometry of transcatheter heart valve (THV) and valve function associated with SAPIEN 3 implantation in patients with bicuspid aortic valve (BAV) stenosis. Methods We included 280 consecutive patients who had a contrast computed tomography (CT) before and after transcath- and results eter aortic valve implantation (TAVI) in our institution. Each THV was assessed by CT at five cross-sectional levels: inflow, annulus, mid, sinus, and outflow. The geometry of THV was assessed for eccentricity (1 – minimum diameter/maximum diameter) and expansion (CT derived external valve area/nominal external valve area). CT measurements and transthoracic echocardiogram data were compared between BAV and tricuspid aortic valve (TAV). Among 280 patients, 41 patients were diagnosed as BAV. Compared to TAV, BAV was associated with lower expansion at mid-level, sinus-level, and outflow-level (mid 94.1 ± 6.8% vs. 98.1 ± 7.8%; P = 0.002, sinus 95.9 ± 7.2% vs. 101.6 ± 8.5%; P < 0.001, outflow 107.6 ± 6.2% vs. 109.9 ± 6.6%; P = 0.043), and higher eccentricity at all levels [inflow 3.5% (1.9–5.3) vs. 6.0% (3.2–7.5); P < 0.001, annulus 3.1% (1.6–5.2) vs. 5.4% (3.1–7.8); P = 0.002, mid 3.0% (1.4–4.9) vs. 6.0% (3.3–10.4); P < 0.001, sinus 3.0% (1.7–5.1) vs. 7.6% (4.0–11.4); P < 0.001, and outflow 2.5% (1.3–4.3) vs. 4.9% (2.2–7.5); P < 0.001]. There were no differences in frequency of paravalvular leak >_ moderate and mean post-procedural gradient between BAV and TAV. Conclusion BAV patients have greater THV eccentricity at all levels and lower THV expansion at mid, sinus, and outflow levels than the TAV patients. There were no differences in parameters of valve function between BAV and TAV patients. Despite the observed geometrical differences, TAVI with SAPIEN 3 in BAV patients allows for feasible valve function.

Original languageEnglish
Pages (from-to)1408-1418
Number of pages11
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number12
StatePublished - 1 Dec 2018
Externally publishedYes


  • Bicuspid aortic valve
  • Computed tomography
  • SAPIEN 3
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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