Redefining TAVR Valve Sizing: A Validated Multiplanar Approach for Both Bicuspid and Tricuspid Valves

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Traditional transcatheter aortic valve replacement (TAVR) sizing relies on annular measurements, which may be insufficient, especially for bicuspid aortic valves (BAVs).
• Current supra-annular assessment methods lack standardization and reproducibility, hindering optimal TAVR device selection.

Purpose of the Study:

• To develop and validate a standardized multiplanar approach for TAVR sizing.
• To integrate both annular and supra-annular measurements for improved accuracy.

Main Methods:

• Retrospective analysis of 377 patients (191 BAVs, 186 tricuspid aortic valves [TAVs]) undergoing TAVR with the Venus A-Valve.
• Implementation of a multiplanar protocol with measurements at 2-mm intervals above the annulus, including commissural and leaflet margin assessments.
• Comparison with a propensity-matched cohort using traditional annulus-based sizing.

Main Results:

• The multiplanar strategy led to downsizing in 89.0% of BAV patients and 64.5% of TAV patients compared to annulus-based sizing.
• No significant differences in outcomes were observed between downsized and non-downsized cases.
• The multiplanar group showed a lower incidence of valve-in-valve procedures (3.1% vs 12.2%, P=0.032).

Conclusions:

• Multiplanar supra-annular measurement offers a comprehensive evaluation of aortic root anatomy.
• This approach enables more precise TAVR sizing for both BAV and TAV patients.
• The strategy improves TAVR outcomes and reduces reintervention rates.