Elastic Recoil and Deployment Asymmetry of the Transcatheter Heart Valve in Bicuspid Versus Tricuspid Anatomy

Abstract

Background: Data supporting the use of transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve (BAV) is limited compared to tricuspid aortic valve (TAV) anatomy, as the BAV anatomy poses unique challenges to prosthesis expansion and symmetric deployment. Aims: We aim to compare the acute recoil and asymmetry of the SAPIEN-3 valve between BAV and TAV anatomies and their impact on procedural outcomes. Methods: We conducted a single-center study of patients who underwent TAVR with the SAPIEN-3 valve. We measured acute recoil, deployment asymmetry, and length asymmetry from intraprocedural angiogram before and after postdilation, as well as before and after predilation. Hemodynamic and procedural outcomes were studied. Results: Among 946 patients, 9% had BAV. In the RAO view, BAV patients had significantly higher absolute and relative acute recoil across all diameters, while in the LAO view, only central diameter relative recoil was significantly higher (p < 0.001). Deployment asymmetry was more common in BAV patients with an OR of 1.88 (CI 1.19, 2.96; p = 0.01). Predilation reduced both length and deployment asymmetry in RAO and LAO views for TAV and BAV patients (p < 0.001). Postdilation significantly reduced acute valve recoil in both groups (p = 0.002 and p = 0.032). Hemodynamic outcomes were comparable between TAV and BAV patients, and there were no significant associations between deployment or length asymmetry and procedural outcomes. Conclusions: Acute recoil, deployment asymmetry, and length asymmetry are common in BAV patients but do not affect short-term clinical outcomes or hemodynamics.