Rotation characteristics and neo‐commissural alignment of transcatheter heart valve in type‐0 bicuspid aortic valve

Aims This study sought to characterize the rotation of the transcatheter heart valve (THV) and evaluate the neo-commissures overlap with coronary arteries in type-0 bicuspid aortic valve (BAV). Methods and Results This was a single-center, 10-patient, retrospective observational cohort. Pre-TAVI computed tomography and procedural fluoroscopy were analyzed. Coplanar fluoroscopic views were coregistered to pre-TAVI computed tomography to characterize THV rotation and determine coronary overlap. The incidence of severe coronary artery overlap with one coronary artery was 90%. According to our prediction line, type-0 BAV has predicted a higher incidence of overlap with one coronary artery, but lower incidence with both coronary arteries compared to the tricuspid aortic valve (TAV). The rotational angles in two different phases were 3.8 +/- 3.2 degrees versus 11.8 +/- 8.0 degrees (p = .01) in patients with mixed cusp fusion. Commissural angles in final and initial deployment were 9.6 +/- 6.6 versus 18.1 +/- 11.0 degrees (p = .021). Applying hypothetic "commissure-middle view" in 0 degrees, +/- 5 degrees, and +/- 10 degrees, the incidence of overlap with one coronary artery are 20%, 40%, and 90% separately. Conclusions The THV rotation existed and was activated in the last 1/3 deploying phase. With the observed tendency of "automatic commissural alignment," applying the "commissure-middle" view in type-0 BAV may optimize valve alignment and avoid coronary artery overlap.