TY - JOUR
T1 - Distribution of C-arm projections in native and bioprosthetic aortic valves cusps
T2 - Implication for BASILICA procedures
AU - Komatsu, Ikki
AU - Tang, Gilbert H.L.
AU - Leipsic, Jonathon
AU - Webb, John G.
AU - Blanke, Philipp
AU - Mackensen, G. Burkhard
AU - Kitamura, Mitsunobu
AU - Wolak, Arik
AU - Don, Creighton W.
AU - McCabe, James M.
AU - Rumer, Christopher
AU - Tan, Christina W.
AU - Levin, Dmitry B.
AU - Ramos, Mario
AU - Aldea, Gabriel S.
AU - Reisman, Mark
AU - Wijeysundera, Harindra C.
AU - Radhakrishnan, Sam
AU - Sathananthan, Janarthanan
AU - Piazza, Nicolo
AU - Kornowski, Ran
AU - Abdel-Wahab, Mohamed
AU - Dvir, Danny
N1 - Funding Information:
Dr.G.H.T is a physician proctor for Medtronic and a consultant for Medtronic, Abbott Structural Heart and W. L. Gore & Associates. Dr. J.M.M. is a consultant to Edwards Lifesciences and Boston Scientific. Dr. H.C.W. received research funding from Medtronic Inc and Edwards Lifesciences. Dr. N.P. is a consultant and proctor for Medtronic and Microport. Dr. M.A.‐W. is a proctor of Edwards Lifesciences and Medtronic. Dr. D.D. is a consultant to Edwards Lifesciences, Medtronic, Gore, Jena, Abbott. All other authors have no potential conflicts of interest to disclose with regard to any part of the data or results in this report.
Publisher Copyright:
© 2020 Wiley Periodicals LLC.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Objectives: We sought to document aortic cusps fluoroscopic projections and their distributions using leaflet alignment which is a novel concept to optimize visualization of leaflets and for guiding BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent coronary artery obstruction) and determine whether these projections were feasible in catheter laboratory. Background: Optimal fluoroscopic projections of aortic valve cusps have not been well described. Methods: A total of 128 pre-transcatheter aortic valve replacement (pre-TAVR) computed tomographies (CT) (72 native valves and 56 bioprosthetic surgical valves) were analyzed. Using CT software (3Mensio, Pie medical imaging, the Netherlands), leaflet alignment was performed and the feasibility of these angles, which were defined as rate of obtainable with efforts (within LAO/RAO of 85° and CRA/CAU of 50°) were evaluated. Results: High feasibility was seen in right coronary cusp (RCC) front view (100%) and left coronary cusp (LCC) side view (99.2%), followed by noncoronary cusp side view (95.3%). In contrast, low feasibility of RCC side view (7.8%) and LCC front view (47.6%) was observed. No statistical differences were seen between the distribution of native valves and bioprosthetic surgical valves. With patient/table tilt of 20°LAO and 10°CRA, the feasibility of RCC side view and LCC front view increased to 43.7 and 85.2%, respectively. Conclusion: Distributions of each cusp's leaflet alignment follows “sigmoid curve” which can provide better understanding of aortic valve cusp orientation in TAVR and BASILICA. RCC side view used in right cusp BASILICA is commonly unachievable in catheter laboratory and may improve with patient/table tilt.
AB - Objectives: We sought to document aortic cusps fluoroscopic projections and their distributions using leaflet alignment which is a novel concept to optimize visualization of leaflets and for guiding BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent coronary artery obstruction) and determine whether these projections were feasible in catheter laboratory. Background: Optimal fluoroscopic projections of aortic valve cusps have not been well described. Methods: A total of 128 pre-transcatheter aortic valve replacement (pre-TAVR) computed tomographies (CT) (72 native valves and 56 bioprosthetic surgical valves) were analyzed. Using CT software (3Mensio, Pie medical imaging, the Netherlands), leaflet alignment was performed and the feasibility of these angles, which were defined as rate of obtainable with efforts (within LAO/RAO of 85° and CRA/CAU of 50°) were evaluated. Results: High feasibility was seen in right coronary cusp (RCC) front view (100%) and left coronary cusp (LCC) side view (99.2%), followed by noncoronary cusp side view (95.3%). In contrast, low feasibility of RCC side view (7.8%) and LCC front view (47.6%) was observed. No statistical differences were seen between the distribution of native valves and bioprosthetic surgical valves. With patient/table tilt of 20°LAO and 10°CRA, the feasibility of RCC side view and LCC front view increased to 43.7 and 85.2%, respectively. Conclusion: Distributions of each cusp's leaflet alignment follows “sigmoid curve” which can provide better understanding of aortic valve cusp orientation in TAVR and BASILICA. RCC side view used in right cusp BASILICA is commonly unachievable in catheter laboratory and may improve with patient/table tilt.
KW - BASILICA
KW - bioprosthetic valve
KW - coronary obstruction
KW - optimal projection
KW - transcatheter aortic valve replacement
KW - transcatheter leaflet laceration
UR - http://www.scopus.com/inward/record.url?scp=85090306954&partnerID=8YFLogxK
U2 - 10.1002/ccd.29224
DO - 10.1002/ccd.29224
M3 - Article
C2 - 32894804
AN - SCOPUS:85090306954
VL - 97
SP - E580-E587
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
SN - 1522-1946
IS - 4
ER -