D-2 | Cardiac Computed Tomography Angiography Anatomical Characterization of Patients with Primary Aortic Regurgitation

BackgroundWe sought to use cardiac computed tomography angiography (CCTA) imaging to identify anatomical characteristics of the aortic root in patients with primary severe aortic regurgitation (AR) as compared to those with aortic stenosis (AS) to judge feasibility of transcatheter aortic valve replacement (TAVR) with the JenaValve Trilogy system.MethodsCCTA was performed prior to planned TAVR for 107 patients with severe AR and 92 patients with severe AS. Measurements related to aortic root and coronary artery anatomy were obtained and compared between groups. Perimeter >85 mm and aortic annulus angle >70 degrees were defined as the theoretical exclusion criteria for TAVR.ResultsThe mean age of patients in the AR group was 74.9 + 11.2 years, 46% were women, and the median Society of Thoracic Surgeons risk score for mortality was 3.6 + 2.1. Comparatively, the mean age of patients in the AS group was 82.3 + 5.53 years, 65 percent were women, and the median STS risk score was 5.5 + 3.3. Annulus area, perimeter, diameter, and angle were larger in patients with severe AR. Sinus of Valsalva diameters and heights were larger in patients with severe AR. More AR patients were excluded based on perimeter (35 vs 5%) and annulus angle (7 vs 1%). More AS patients exhibited high-risk anatomy for left main coronary occlusion (21 vs 7%) and right coronary occlusion (14 vs 3%). The maximum dimension of the ascending aorta was larger in patients with severe AR. The percentage of AR patients with aortopathy requiring surgical intervention is very low.ConclusionsA larger proportion of patients with severe AR are excluded from TAVR as compared to AS due to large aortic annulus size and horizontal angulation. The most prevalent excluding factor is aortic annulus size, with many fewer patients excluded due to angulation. Larger transcatheter valve sizes would help to treat a larger proportion of AR patients.DisclosuresV. H. Thourani: Abbott: Consulting and Principal Investigator for a Research Study; Boston Scientific Corp.: Consulting; Edwards Lifesciences: Consulting and Principal Investigator for a Research Study; shockwave: Consulting; cryolife: Consulting; jenavalve: Principal Investigator for a Research Study; O. Khalique: Abbott: Consulting; Edwards Lifesciences: Consulting; S. Gogia Nothing to disclose. T. Vahl Nothing to disclose. I. George Nothing to disclose. S. K. Kodali Nothing to disclose. N. Hamid Nothing to disclose. M. Matsumura Nothing to disclose. A. Maehara Nothing to disclose. T. Chen Nothing to disclose. H. Treede Nothing to disclose. S. Baldus Nothing to disclose. D. Daniels Nothing to disclose. M. J. Russo Nothing to disclose. J. M. McCabe Nothing to disclose. S. J. Chetcuti Nothing to disclose. M. B. Leon Nothing to disclose. R. Makkar Nothing to disclose. BackgroundWe sought to use cardiac computed tomography angiography (CCTA) imaging to identify anatomical characteristics of the aortic root in patients with primary severe aortic regurgitation (AR) as compared to those with aortic stenosis (AS) to judge feasibility of transcatheter aortic valve replacement (TAVR) with the JenaValve Trilogy system. We sought to use cardiac computed tomography angiography (CCTA) imaging to identify anatomical characteristics of the aortic root in patients with primary severe aortic regurgitation (AR) as compared to those with aortic stenosis (AS) to judge feasibility of transcatheter aortic valve replacement (TAVR) with the JenaValve Trilogy system. MethodsCCTA was performed prior to planned TAVR for 107 patients with severe AR and 92 patients with severe AS. Measurements related to aortic root and coronary artery anatomy were obtained and compared between groups. Perimeter >85 mm and aortic annulus angle >70 degrees were defined as the theoretical exclusion criteria for TAVR. CCTA was performed prior to planned TAVR for 107 patients with severe AR and 92 patients with severe AS. Measurements related to aortic root and coronary artery anatomy were obtained and compared between groups. Perimeter >85 mm and aortic annulus angle >70 degrees were defined as the theoretical exclusion criteria for TAVR. ResultsThe mean age of patients in the AR group was 74.9 + 11.2 years, 46% were women, and the median Society of Thoracic Surgeons risk score for mortality was 3.6 + 2.1. Comparatively, the mean age of patients in the AS group was 82.3 + 5.53 years, 65 percent were women, and the median STS risk score was 5.5 + 3.3. Annulus area, perimeter, diameter, and angle were larger in patients with severe AR. Sinus of Valsalva diameters and heights were larger in patients with severe AR. More AR patients were excluded based on perimeter (35 vs 5%) and annulus angle (7 vs 1%). More AS patients exhibited high-risk anatomy for left main coronary occlusion (21 vs 7%) and right coronary occlusion (14 vs 3%). The maximum dimension of the ascending aorta was larger in patients with severe AR. The percentage of AR patients with aortopathy requiring surgical intervention is very low. The mean age of patients in the AR group was 74.9 + 11.2 years, 46% were women, and the median Society of Thoracic Surgeons risk score for mortality was 3.6 + 2.1. Comparatively, the mean age of patients in the AS group was 82.3 + 5.53 years, 65 percent were women, and the median STS risk score was 5.5 + 3.3. Annulus area, perimeter, diameter, and angle were larger in patients with severe AR. Sinus of Valsalva diameters and heights were larger in patients with severe AR. More AR patients were excluded based on perimeter (35 vs 5%) and annulus angle (7 vs 1%). More AS patients exhibited high-risk anatomy for left main coronary occlusion (21 vs 7%) and right coronary occlusion (14 vs 3%). The maximum dimension of the ascending aorta was larger in patients with severe AR. The percentage of AR patients with aortopathy requiring surgical intervention is very low. ConclusionsA larger proportion of patients with severe AR are excluded from TAVR as compared to AS due to large aortic annulus size and horizontal angulation. The most prevalent excluding factor is aortic annulus size, with many fewer patients excluded due to angulation. Larger transcatheter valve sizes would help to treat a larger proportion of AR patients. A larger proportion of patients with severe AR are excluded from TAVR as compared to AS due to large aortic annulus size and horizontal angulation. The most prevalent excluding factor is aortic annulus size, with many fewer patients excluded due to angulation. Larger transcatheter valve sizes would help to treat a larger proportion of AR patients.