Characteristics of aortic root and vascular anatomy in bicuspid versus tricuspid aortic valve stenosis in patients undergoing Transcatheter aortic valve implantation

Ziad Arow ¹ Yaron Aviv ¹ Mithal Nassar ¹ Gidon Perlman ² Jonathan Lessick ³ Yafim Brodov ⁴ Hana Vaknin-Assa ¹ Arik Stienvil ⁵ Ran Kornowski ¹ Ashraf Hamdan ¹

¹Department of Cardiology, Rabin medical center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
²Department of Cardiology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
³Department of Cardiology, Rambam Medical Center, Technion University, Haifa, Israel
⁴Department of Cardiology, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
⁵Department of Cardiology, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

Background: Transcatheter aortic valve implantation (TAVI) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS).

Objectives: This study sought to compare aortic root and ilio-femoral artery characteristics and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVI multicenter registry.

Methods: 88 patients with bicuspid AS and 213 matched patients with tricuspid AS were referred for pre-procedural computed tomography (CT) evaluation before TAVI. We performed a detailed assessment of aortic root anatomy: size of the annulus, sinus of Valsalva (SoV), sino-tubular junction (STJ); we also determined the dimensions of aorta, left subclavian, and ilio-femoral arteries.

Results: Patients with bicuspid AS had significantly larger aortic root dimensions, (annulus mean diameter: 25.5 ± 2.9 mm vs. 23.7 ± 2.4 mm, SoV mean diameter: 35.3 ± 4.7 mm vs. 32 ± 4.4mm, STJ mean diameter: 31.5 ± 4.9 mm vs. 27.6 ± 3.5 mm; respectively) than patients with tricuspid AS (P value for all < 0.001), even after adjustment for their larger BSA and height. Dimensions of ascending aorta, left subclavian artery, and ilio-femoral arteries were also consistently larger in bicuspid than in tricuspid AS morphology.

Conclusions: Patients with bicuspid AS had significantly larger aortic root dimensions, larger ascending aorta, subclavian artery and ilio-femoral arteries even after adjustment for their BSA and height.