Impact of Calcified Raphe on TAVR in Bicuspid Patients: Predicting Redo-TAVR Feasibility and Virtual Planning Implications

Reddy, P; Rodriguez-Weisson, FJ; Medranda, GA; Merdler, I; Cellamare, M; Gordon, P; Ehsan, A; Parikh, P; Bilfinger, T; Buchbinder, M; Roberts, D; Hanna, N; Ben-Dor, I; Satler, LF; Garcia-Garcia, HM; Asch, FM; Weissman, G; Sadeghpour, A; Schults, CC; Waksman, R; Rogers, T

doi:10.1161/circinterventions.124.014802

Impact of Calcified Raphe on Transcatheter Aortic Valve Replacement (TAVR) in Bicuspid Patients: Predicting Redo-TAVR Feasibility and Virtual Planning Implications

Circ Cardiovasc IntervPublished 22 Apr 2025Computed tomography study of bicuspid patients in the LRT trial (Low Risk TAVR), with development of a predictive virtual valve planning algorithm

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Authors' conclusion

Calcified raphe in left/right cusp fusion shifts the THV away from the coronary ostia, reducing coronary obstruction risk during redo-TAVR. Underexpansion causing increased THV frame height and valve shifting is common in bicuspid patients; a virtual planning algorithm accounting for these aspects can accurately assess redo-TAVR risk.

Study context

Population: Patients with bicuspid aortic stenosis who received a balloon-expandable transcatheter heart valve (THV) in the LRT trial (Low Risk TAVR)left/right cusp fusion 34 · right/noncusp fusion 4 · 2-sinus 4
Participants: 42 patientsEvents: 64%

Predictors: Bicuspid virtual planning algorithm accounting for 83.4% THV underexpansion, resulting in an 11.9% taller frame and translation of the THV away from the calcified raphe (mean valve shift 6.6 mm)
Predicted outcome: redo-TAVR feasibility

Methodological detailsbaseline and 30-day computed tomography scans, balloon-expandable transcatheter heart valve (THV)

Baseline and 30-day computed tomography scans
Balloon-expandable transcatheter heart valve (THV)

Model performance

As reported in the abstract

Sensitivity

86.7%

Specificity

88.9%

Further findings

Redo-TAVR feasibility in left/right fusion, calcified raphe vs not

Left/right fusion with calcified raphe88%

Comparator35%

Redo-TAVR feasibility in left/right fusion, calcified raphe vs not: P <0.001
Redo-TAVR feasibility in left/right fusion, calcified raphe vs not: due to favorable shifting of the THV away from the coronary ostia

Redo-TAVR feasibility

Redo-TAVR feasible: 64%
Would likely require leaflet modification to prevent coronary obstruction: 36%

Original publication

Impact of Calcified Raphe on TAVR in Bicuspid Patients: Predicting Redo-TAVR Feasibility and Virtual Planning Implications. Circ Cardiovasc Interv. Published 22 April 2025. doi:10.1161/circinterventions.124.014802

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