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The ABC Bicuspid Sizing Protocol for SAPIEN 3 Balloon-Expandable Valves
Tej Sheth1, Umar Ismail1, Jorge Chavarria1
1Division of Cardiology and Cardiac Surgery, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
Structural Heart : the Journal of the Heart Team
|September 2, 2025
Summary
A new sizing algorithm for balloon-expandable valves (BEV) in bicuspid aortic stenosis transcatheter aortic valve replacement (TAVR) shows high success. This method accurately selects patients, achieving excellent technical and device success rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Accurate patient selection for balloon-expandable valve (BEV) transcatheter aortic valve replacement (TAVR) in bicuspid aortic stenosis remains challenging.
- Computed tomography (CT) is crucial for pre-procedural assessment.
Purpose of the Study:
- To evaluate a novel sizing algorithm for SAPIEN 3 BEV in patients with bicuspid aortic stenosis.
- To assess the algorithm's efficacy in patient selection for TAVR.
Main Methods:
- A prospective single-center registry included patients with bicuspid aortic stenosis undergoing TAVR or surgical aortic valve replacement.
- The ABC bicuspid sizing algorithm criteria included annular area, left ventricular outflow tract (LVOT) area, intercommissural distance, sinus diameter, and leaflet calcification.
- Study endpoints were technical and device success at 30 days.
Main Results:
- 106 patients underwent TAVR, and 10 had surgical AVR due to anatomical constraints.
- The algorithm guided final valve sizing in most TAVR patients, primarily by annular area (77.5%) and LVOT area (21.7%).
- High rates of technical success (99%) and 30-day device success (96.2%) were achieved.
Conclusions:
- A dedicated sizing algorithm for BEVs effectively selects patients for TAVR in bicuspid aortic stenosis.
- The algorithm facilitated high device success rates, improving patient selection for this procedure.
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