Dynamic Anatomy of Aortic Root and Its Potential Role in TAVR Prostheses Further Development and Modification

Abstract

Aortic stenosis (AS) is the most common valvular disorder. Surgical aortic valve replacement is the definitive therapy for patients with severe AS. In the last years transcatheter aortic valve replacement (TAVR) has been developed as an alternative to surgical aortic valve replacement with promising results. Despite being less invasive than open-chest aortic valve replacement, good outcome and effectiveness of TAVR procedure, it remains associated with the potential for serious complications and short-time durability. Today there are two TAVR prostheses that have CE marks and FDA approved: Edwards Valves and CoreValve. Besides there are many other newly developed TAVR prostheses on the stage of clinical trials. However, no one of them had been developed on the base of data for dynamic anatomy of human aortic root because of the lack of appropriate imaging modality. Today, different two-dimensional (2D) and three-dimensional (3D) imaging techniques are used for aortic root examination. But no one of them has been accepted as a “gold standard” imaging modality for assessment of dynamic anatomy of aortic root. The existing imaging modalities such as transthoracic echocardiography, transesophageal echocardiography, angiography, CT and MRI scans provide tangential cut plane view which did not reflect the real sizes of the annulus and other aortic root rings and structures. Obtained with these modalities images did not reflect the changes of the size and shapes of the anatomic structures of aortic root during the different phase of cardiac cycles either. Today there are strict needs for imaging modality which could assist in assessment of dynamic aortic root to push the TAVR prosthesis design and modification on new level.