Methods for improved bileaflet aortic valve detection prior to transcatheter aortic valve replacement

Area of Science:

• Cardiology
• Radiology
• Anatomy

Background:

• Bileaflet aortic valve prevalence is not well-defined in transcatheter aortic valve replacement (TAVR) patients.
• Accurate pre-procedural diagnosis of aortic valve morphology is crucial for TAVR planning.
• Existing diagnostic methods for aortic valve morphology prior to TAVR have limitations.

Purpose of the Study:

• To determine the prevalence of bileaflet aortic valves in a TAVR cohort.
• To identify imaging features on cardiac computed tomography angiography (CTA) that improve bileaflet valve detection.
• To investigate the association between aortic valve morphology and permanent pacemaker implantation (PPI) after TAVR.

Main Methods:

• Retrospective analysis of pre-procedural cardiac CTA reports and imaging in TAVR patients.
• Expert review of cardiac CTA to assess aortic valve morphology, including commissural angles and heights.
• Comparison of CTA-based morphology assessment with historical diagnoses.
• Statistical analysis to determine relationships between valve morphology and PPI post-TAVR.

Main Results:

• Out of 433 TAVR patients, 9.2% had bileaflet aortic valves, with 80% misdiagnosed in initial reports.
• A commissural angle threshold of 141.1 degrees demonstrated 73% sensitivity and 86% specificity for identifying bileaflet valves.
• Patients with bileaflet valves had a significantly higher rate of PPI post-TAVR (38% vs. 19%, p=0.0114).

Conclusions:

• Bileaflet aortic valves are frequently misdiagnosed in TAVR candidates.
• Measuring the commissural angle on pre-procedural CTA can enhance diagnostic accuracy.
• Improved detection of bileaflet valves may lead to better TAVR outcomes and reduced PPI rates.