Skip to main content

Structural Design of Transcatheter Aortic Valves: General Concepts Related to Imaging

  • Chapter
  • First Online:
Multimodality Imaging for Transcatheter Aortic Valve Replacement

Abstract

Transcatheter aortic valve replacement (TAVR) is an alternative approach in patients deemed “high risk” or “inoperable” for surgical aortic valve replacement (sAVR) [1–4]. A number of novel transcatheter heart valves (THVs) have been developed over the past decade, each with unique features that may provide potential advantages in patients undergoing TAVR. Unlike surgical valves, wherein the native aortic valve is resected, directly visualized, and a surgical valve is sewn into the aortic annulus, aortic THVs must expand and both conform to the native aortic annulus and interact with critical structures in the aortic valvar complex, including the thickened and rigid native valve leaflets and left ventricular outflow tract and membranous septum.

Relationship with Industry: Jeffrey J. Popma: Research Grants: Medtronic Vascular, Boston Scientific, Abbott Vascular, Cordis Corporation, Medrad, Covidien. Advisory Boards: Boston Scientific, Abbott Vascular.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 159.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 209.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366(18):1686–95.

    Article  PubMed  CAS  Google Scholar 

  2. Makkar RR, Fontana GP, Jilaihawi H, Kapadia S, Pichard AD, Douglas PS, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2012;366(18):1696–704.

    Article  PubMed  CAS  Google Scholar 

  3. Reynolds MR, Magnuson EA, Lei Y, Walczak J, Vilaine K, Zajarias A, et al. Cost effectiveness of transcatheter aortic valve replacement compared with surgical aortic valve replacement in patients with severe aortic stenosis: results from the PARTNER trial. J Am Coll Cardiol. 2011;58(20):xiii.

    Google Scholar 

  4. Reynolds MR, Magnuson EA, Wang K, Lei Y, Vilain K, Walczak J, et al. Cost-effectiveness of transcatheter aortic valve replacement compared with standard care among inoperable patients with severe aortic stenosis: results from the placement of aortic transcatheter valves (PARTNER) trial (Cohort B). Circulation. 2012;125(9): 1102–9.

    Article  PubMed  Google Scholar 

  5. Paterick TE, Jan MF, Paterick ZR, Tajik AJ, Gerber TC. Cardiac imaging modalities with ionizing radiation: the role of informed consent. JACC Cardiovasc Imaging. 2012;5(6):634–40.

    Article  PubMed  Google Scholar 

  6. FDA. Draft Guidance for Industry and FDA Staff: Heart Valves – Investigational Device Exemption (IDE) and Premarket Approval (PMA) Applications. http://www.fda.gov/medicaldevices/deviceregulationandguidance/guidancedocuments/ucm193096.htm 2011.

  7. Schultz CJ, Tzikas A, Moelker A, Rossi A, Nuis RJ, Geleijnse MM, et al. Correlates on MDCT of paravalvular aortic regurgitation after transcatheter aortic valve implantation using the medtronic CoreValve prosthesis. Catheter Cardiovasc Interv. 2011;78(3):446–55.

    PubMed  Google Scholar 

  8. Willson AB, Rodes-Cabau J, Wood DA, Leipsic J, Cheung A, Toggweiler S, et al. Transcatheter aortic valve replacement with the St. Jude Medical Portico valve: first-in-human experience. J Am Coll Cardiol. 2012;60(7):581–6.

    Article  PubMed  Google Scholar 

  9. Low RI, Bolling SF, Yeo KK, Ebner A. Direct flow medical percutaneous aortic valve: proof of concept. EuroIntervention. 2008;4(2):256–61.

    Article  PubMed  Google Scholar 

  10. Gada H, Kapadia SR, Tuzcu EM, Svensson LG, Marwick TH. Markov model for selection of aortic valve replacement versus transcatheter aortic valve implantation (without replacement) in high-risk patients. Am J Cardiol. 2012;109(9):1326–33.

    Article  PubMed  Google Scholar 

  11. Kempfert J, Treede H, Rastan AJ, Schonburg M, Thielmann M, Sorg S, et al. Transapical aortic valve implantation using a new self-expandable bioprosthesis (ACURATE TA): 6-month outcomes. Eur J Cardiothorac Surg. 2013;43(1):52–6.

    Article  PubMed  Google Scholar 

  12. Sundermann SH, Grunenfelder J, Corti R, Rastan AJ, Linke A, Lange R, et al. Feasibility of the Engager aortic transcatheter valve system using a flexible over-the-wire design. Eur J Cardiothorac Surg. 2012;42(4):e48–52.

    Article  PubMed  Google Scholar 

  13. Treede H, Mohr FW, Baldus S, Rastan A, Ensminger S, Arnold M, et al. Transapical transcatheter aortic valve implantation using the JenaValve system: acute and 30-day results of the multicentre CE-mark study. Eur J Cardiothorac Surg. 2012;41(6):e131–8.

    Article  PubMed  Google Scholar 

  14. Altiok E, Koos R, Schroder J, Brehmer K, Hamada S, Becker M, et al. Comparison of two-dimensional and three-dimensional imaging techniques for measurement of aortic annulus diameters before transcatheter aortic valve implantation. Heart. 2011;97(19): 1578–84.

    Article  PubMed  Google Scholar 

  15. Dashkevich A, Blanke P, Siepe M, Pache G, Langer M, Schlensak C, et al. Preoperative assessment of aortic annulus dimensions: comparison of noninvasive and intraoperative measurement. Ann Thorac Surg. 2011;91(3):709–14.

    Article  PubMed  Google Scholar 

  16. Gurvitch R, Webb JG, Yuan R, Johnson M, Hague C, Willson AB, et al. Aortic annulus diameter determination by multidetector computed tomography: reproducibility, applicability, and implications for transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2011;4(11):1235–45.

    Article  PubMed  Google Scholar 

  17. Leipsic J, Gurvitch R, Labounty TM, Min JK, Wood D, Johnson M, et al. Multidetector computed tomography in transcatheter aortic valve implantation. JACC Cardiovasc Imaging. 2011;4(4):416–29.

    Article  PubMed  Google Scholar 

  18. Schoenhagen P, Tuzcu EM, Kapadia SR, Desai MY, Svensson LG. Three-dimensional imaging of the aortic valve and aortic root with computed tomography: new standards in an era of transcatheter valve repair/implantation. Eur Heart J. 2009;30(17):2079–86.

    Google Scholar 

  19. Schultz CJ, Moelker A, Piazza N, Tzikas A, Otten A, Nuis RJ, et al. Three dimensional evaluation of the aortic annulus using multislice computer tomography: are manufacturer’s guidelines for sizing for percutaneous aortic valve replacement helpful? Eur Heart J. 2010;31(7):849–56.

    Article  PubMed  Google Scholar 

  20. Jabbour A, Ismail TF, Moat N, Gulati A, Roussin I, Alpendurada F, et al. Multimodality imaging in transcatheter aortic valve implantation and post-procedural aortic regurgitation: comparison among cardiovascular magnetic resonance, cardiac computed tomography, and echocardiography. J Am Coll Cardiol. 2011;58(21):2165–73.

    Article  PubMed  Google Scholar 

  21. Hutter A, Opitz A, Bleiziffer S, Ruge H, Hettich I, Mazzitelli D, et al. Aortic annulus evaluation in transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2010;76(7):1009–19.

    Article  PubMed  Google Scholar 

  22. Kempfert J, Van Linden A, Lehmkuhl L, Rastan AJ, Holzhey D, Blumenstein J, et al. Aortic annulus sizing: echocardiographic vs. computed tomography derived measurements in comparison with direct surgical sizing. Eur J Cardiothorac Surg. 2012;42(4):627–33.

    Article  PubMed  Google Scholar 

  23. Messika-Zeitoun D, Serfaty JM, Brochet E, Ducrocq G, Lepage L, Detaint D, et al. Multimodal assessment of the aortic annulus diameter: implications for transcatheter aortic valve implantation. J Am Coll Cardiol. 2010;55(3):186–94.

    Article  PubMed  Google Scholar 

  24. Tamborini G, Fusini L, Gripari P, Muratori M, Cefalu C, Maffessanti F, et al. Feasibility and accuracy of 3DTEE versus CT for the evaluation of aortic valve annulus to left main ostium distance before transcatheter aortic valve implantation. JACC Cardiovasc Imaging. 2012;5(6):579–88.

    Article  PubMed  Google Scholar 

  25. Tzikas A, Schultz CJ, Piazza N, Moelker A, Van Mieghem NM, Nuis RJ, et al. Assessment of the aortic annulus by multislice computed tomography, contrast aortography, and trans-thoracic echocardiography in patients referred for transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2011;77(6):868–75.

    Article  PubMed  Google Scholar 

  26. Willson AB, Webb JG, Labounty TM, Achenbach S, Moss R, Wheeler M, et al. 3-dimensional aortic annular assessment by multidetector computed tomography predicts moderate or severe paravalvular regurgitation after transcatheter aortic valve replacement: a multicenter retrospective analysis. J Am Coll Cardiol. 2012;59(14):1287–94.

    Article  PubMed  Google Scholar 

  27. Jilaihawi H, Kashif M, Fontana G, Furugen A, Shiota T, Friede G, et al. Cross-sectional computed tomographic assessment improves accuracy of aortic annular sizing for transcatheter aortic valve replacement and reduces the incidence of paravalvular aortic regurgitation. J Am Coll Cardiol. 2012;59(14):1275–86.

    Article  PubMed  Google Scholar 

  28. Hamdan A, Guetta V, Konen E, Goitein O, Segev A, Raanani E, et al. Deformation dynamics and mechanical properties of the aortic annulus by 4-dimensional computed tomography insights into the functional anatomy of the aortic valve complex and implications for transcatheter aortic valve therapy. J Am Coll Cardiol. 2012;59(2):119–27.

    Article  PubMed  Google Scholar 

  29. Delgado V, Ng AC, van de Veire NR, van der Kley F, Schuijf JD, Tops LF, et al. Transcatheter aortic valve implantation: role of multi-detector row computed tomography to evaluate prosthesis positioning and deployment in relation to valve function. Eur Heart J. 2010;31(9):1114–23.

    Article  PubMed  Google Scholar 

  30. Anderson RH. Clinical anatomy of the aortic root. Heart. 2000;84(6):670–3.

    Article  PubMed  CAS  Google Scholar 

  31. Anderson R, Becker A, Piazza N. The anatomy of the aortic valvar complex. In: Serruys P, Piazza N, Cribier A, Webb J, Laborde J-C, de Jaegere P, editors. Transcatheter aortic valve implantation: tips and tricks to avoid failure. New York/London: Informa Healthcare; 2010. p. 1–17.

    Google Scholar 

  32. Owens DS, Budoff MJ, Katz R, Takasu J, Shavelle DM, Carr JJ, et al. Aortic valve calcium independently predicts coronary and cardiovascular events in a primary prevention population. JACC Cardiovasc Imaging. 2012;5(6):619–25.

    Article  PubMed  Google Scholar 

  33. Yared K, Garcia-Camarero T, Fernandez-Friera L, Llano M, Durst R, Reddy AA, et al. Impact of aortic regurgitation after transcatheter aortic valve implantation: results from the REVIVAL trial. JACC Cardiovasc Imaging. 2012;5(5):469–77.

    Article  PubMed  Google Scholar 

  34. Haensig M, Lehmkuh L, Holzhey D, Mukherjee C, Kempfert J, Walther T, et al. Aortic valve calcium scoring (AVCS) is a predictor of significant paravalvular aortic insufficiency in transapical aortic valve implantation. J Am Coll Cardiol. 2011;58(20):B203.

    Google Scholar 

  35. Haensig M, Lehmkuhl L, Rastan AJ, Kempfert J, Mukherjee C, Gutberlet M, et al. Aortic valve calcium scoring is a predictor of significant paravalvular aortic insufficiency in transapical-aortic valve implantation. Eur J Cardiothorac Surg. 2012;41(6):1234–40.

    Article  PubMed  Google Scholar 

  36. John D, Buellesfeld L, Yuecel S, Mueller R, Latsios G, Beucher H, et al. Correlation of Device landing zone calcification and acute procedural success in patients undergoing transcatheter aortic valve implantations with the self-expanding CoreValve prosthesis. JACC Cardiovasc Interv. 2010;3(2):233–43.

    Article  PubMed  Google Scholar 

  37. Koos R, Mahnken AH, Dohmen G, Brehmer K, Gunther RW, Autschbach R, et al. Association of aortic valve calcification severity with the degree of aortic regurgitation after transcatheter aortic valve implantation. Int J Cardiol. 2011;150(2):142–5.

    Article  PubMed  Google Scholar 

  38. Nombela-Franco L, Rodes-Cabau J, DeLarochelliere R, Larose E, Doyle D, Villeneuve J, et al. Predictive factors, efficacy, and safety of balloon post-dilation after transcatheter aortic valve implantation with a balloon-expandable valve. JACC Cardiovasc Interv. 2012;5(5):499–512.

    Article  PubMed  Google Scholar 

  39. Jatene MB, Monteiro R, Guimaraes MH, Veronezi SC, Koike MK, Jatene FB, et al. Aortic valve assessment. Anatomical study of 100 healthy human hearts. Arq Bras Cardiol. 1999;73(1):75–86.

    Article  PubMed  CAS  Google Scholar 

  40. McAlpine W. An introduction to the aortoventricular unit. In: McAlpine W, editor. An anatomical atlas for clinical diagnosis, radiological investigation, and surgical treatment. Berlin: Springer; 1975. p. 9–27.

    Google Scholar 

  41. Abedin Z, Goldberg J. Origin and length of left main coronary artery: its relation to height, weight, sex, age, pattern of coronary distribution, and presence or absence of coronary artery disease. Cathet Cardiovasc Diagn. 1978;4(3):335–40.

    Article  PubMed  CAS  Google Scholar 

  42. Tops LF, Wood DA, Delgado V, Schuijf JD, Mayo JR, Pasupati S, et al. Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement. JACC Cardiovasc Imaging. 2008;1(3):321–30.

    Article  PubMed  Google Scholar 

  43. Akhtar M, Tuzcu EM, Kapadia SR, Svensson LG, Greenberg RK, Roselli EE, et al. Aortic root morphology in patients undergoing percutaneous aortic valve replacement: evidence of aortic root remodeling. J Thorac Cardiovasc Surg. 2009;137(4):950–6.

    Article  PubMed  Google Scholar 

  44. Knight J, Kurtcuoglu V, Muffly K, Marshall Jr W, Stolzmann P, Desbiolles L, et al. Ex vivo and in vivo coronary ostial locations in humans. Surg Radiol Anat. 2009;31(8):597–604.

    Article  PubMed  Google Scholar 

  45. Gogas BD, Zacharoulis AA, Antoniadis AG. Acute coronary occlusion following TAVR. Catheter Cardiovasc Interv. 2011;77(3):435–8.

    Article  PubMed  Google Scholar 

  46. Kapadia SR, Svensson L, Tuzcu EM. Successful percutaneous management of left main trunk occlusion during percutaneous aortic valve replacement. Catheter Cardiovasc Interv. 2009;73(7):966–72.

    Article  PubMed  Google Scholar 

  47. Tuzcu EM, Kapadia SR. Left main occlusion with transcatheter aortic valve replacement. Catheter Cardiovasc Interv. 2011;78(4):660–1.

    Article  PubMed  Google Scholar 

  48. Seipelt RG, Hanekop GG, Schoendube FA, Schillinger W. Heart team approach for transcatheter aortic valve implantation procedures complicated by coronary artery occlusion. Interact Cardiovasc Thorac Surg. 2012;14(4):431–3.

    Article  PubMed  Google Scholar 

  49. Webb JG. Coronary obstruction due to transcatheter valve implantation. Catheter Cardiovasc Interv. 2009;73(7):973.

    Article  PubMed  Google Scholar 

  50. Gurvitch R, Cheung A, Bedogni F, Webb JG. Coronary obstruction following transcatheter aortic valve-in-valve implantation for failed surgical bioprostheses. Catheter Cardiovasc Interv. 2011;77(3):439–44.

    Article  PubMed  Google Scholar 

  51. Bagur R, Rodes-Cabau J, Gurvitch R, Dumont E, Velianou JL, Manazzoni J, et al. Need for permanent pacemaker as a complication of transcatheter aortic valve implantation and surgical aortic valve replacement in elderly patients with severe aortic stenosis and similar baseline electrocardiographic findings. JACC Cardiovasc Interv. 2012;5(5):540–51.

    Article  PubMed  Google Scholar 

  52. Houthuizen P, Van Garsse LA, Poels TT, de Jaegere P, van der Boon RM, Swinkels BM, et al. Left bundle-branch block induced by transcatheter aortic valve implantation increases risk of death. Circulation. 2012;126(6):720–8.

    Article  PubMed  Google Scholar 

  53. Buellesfeld L, Stortecky S, Heg D, Hausen S, Mueller R, Wenaweser P, et al. Impact of permanent pacemaker implantation on clinical outcome among patients undergoing transcatheter aortic valve implantation. J Am Coll Cardiol. 2012;60(6):493–501.

    Article  PubMed  Google Scholar 

  54. Chorianopoulos E, Krumsdorf U, Pleger ST, Katus HA, Bekeredjian R. Improved procedural results after CoreValve implantation with the new AccuTrak delivery system. J Interv Cardiol. 2012;25(2): 174–9.

    Article  PubMed  Google Scholar 

  55. Munoz-Garcia A, Garcia JMH, Briales JHA, Navarro MFJ, Franco A, Mora MJM, et al. Impact of the need for permanent pacemaker requirement after coreValve prosthesis implantation with the new Accutrak delivery Catheter System. J Am Coll Cardiol. 2011;58(20):B202.

    Google Scholar 

  56. Tchetche D, Modine T, Farah B, Vahdat O, Sudre A, Koussa M, et al. Update on the need for a permanent pacemaker after transcatheter aortic valve implantation using the CoreValve(R) Accutrak system. EuroIntervention. 2012;8(5):556–62.

    Article  PubMed  Google Scholar 

  57. Piazza N, Marra S, Webb J, D’Amico M, Rinaldi M, Boffini M, et al. Two cases of aneurysm of the anterior mitral valve leaflet associated with transcatheter aortic valve endocarditis: a mere coincidence? J Thorac Cardiovasc Surg. 2010;140(3):e36–8.

    Article  PubMed  Google Scholar 

  58. Wong DR, Boone RH, Thompson CR, Allard MF, Altwegg L, Carere RG, et al. Mitral valve injury late after transcatheter aortic valve implantation. J Thorac Cardiovasc Surg. 2009;137(6):1547–9.

    Article  PubMed  Google Scholar 

  59. Mesa Rubio D, Suarez de Lezo Cruz Conde J, Alvarez-Osorio MP, Ruiz Ortiz M, Delgado Ortega M, Leon del Pino Mdel C, et al. Measurement of aortic valve annulus using different cardiac imaging techniques in transcatheter aortic valve implantation: agreement with finally implanted prosthesis size. Echocardiography. 2011;28(4):388–96.

    Article  PubMed  Google Scholar 

  60. Schultz CJ, Weustink A, Piazza N, Otten A, Mollet N, Krestin G, et al. Geometry and degree of apposition of the CoreValve ReValving system with multislice computed tomography after implantation in patients with aortic stenosis. J Am Coll Cardiol. 2009;54(10):911–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jeffrey J. Popma MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Popma, J.J., Almonacid, A., Litmanovich, D., Gellert, G. (2014). Structural Design of Transcatheter Aortic Valves: General Concepts Related to Imaging. In: Min, J., Berman, D., Leipsic, J. (eds) Multimodality Imaging for Transcatheter Aortic Valve Replacement. Springer, London. https://doi.org/10.1007/978-1-4471-2798-7_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2798-7_8

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2797-0

  • Online ISBN: 978-1-4471-2798-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics