Hinge point-based annular plane with abnormal aortic cusps in transcatheter aortic valve replacement.

Area of Science:

• Cardiovascular Surgery
• Medical Imaging
• Biomedical Engineering

Background:

• Transcatheter aortic valve replacement (TAVR) commonly utilizes a hinge point-based annular plane (HPAP) for virtual annular plane construction.
• Abnormal aortic cusps (AAC) present significant challenges during TAVR due to their unequal lengths and sizes.
• These anatomical variations can distort the relationship between the HPAP and the aortic root axis, complicating valve deployment.

Purpose of the Study:

• To investigate the impact of abnormal aortic cusps (AAC) on the hinge point-based annular plane (HPAP) during transcatheter aortic valve replacement (TAVR).
• To explore the potential benefits of incorporating a centreline-based aortic annular plane to better understand and manage valve deployment in the presence of AAC.

Main Methods:

• Utilized virtual imaging techniques to construct a hinge point-based annular plane (HPAP).
• Analyzed the influence of abnormal aortic cusps (AAC) on the spatial relationship between the HPAP and the aortic root axis.
• Proposed the integration of a centreline-based annular plane for enhanced analysis.

Main Results:

• Abnormal aortic cusps (AAC) significantly alter the relationship between the HPAP and the aortic root axis.
• These alterations pose challenges for accurate valve deployment during TAVR.
• The study suggests that AAC can lead to complications such as paravalvular leak and valve embolisation.

Conclusions:

• The standard HPAP may be insufficient for optimal TAVR planning in patients with AAC.
• Incorporating a centreline-based aortic annular plane could provide crucial additional information.
• This enhanced approach may improve valve deployment accuracy and reduce TAVR-related complications in cases of AAC.