P116. Aortic Valve Commissural Alignment is Asymmetric in Tricuspid Valves: A New Perspective for Aortic Valve Sparing Operations
Presented During: Adult Cardiac Poster Session II
NewYork- Presbyterian/Columbia University Medical Center
Fort lee, NJ
United States - Contact Me
Yuichiro Kitada is a cardiovascular resident at Saitama Medical Center, Jichi Medical University. He completed medical school at the Okayama University in Japan. He holds board-certified for Japanese genelral surgery and Japanese cardiovascular surgery. His clinical interests include cardiac and aortic surgery.
Monday, May 4, 2026: 9:00 AM - 4:00 PM
McCormick Place Lakeside Center
Room: Exhibit Hall, Poster Area
Description
Objective: In VSRR for tricuspid aortic valve (TAV), the three native commissures are typically resuspended equally 120 degrees apart, assuming equal symmetry of the native commissural alignment (CA). Previous studies have shown a frequent need for free margin plication even for patients with no AR. We speculated that this may be due to asymmetric cusps and coaptation mechanism. The study objective is to assess the symmetry of the cusps and coaptation.
Methods: EKG-gated CTAs obtained in diastole phase were analyzed with 3D reconstruction software. A virtual circle was formed by connecting the three commissural peaks. CA was defined as the angle between each commissure and the circle's center. Coaptation point was defined as the junction of the free margins of all three cusps. Of 132 patients with mild or less AR who underwent VSRR for root aneurysm (ANEURYSM), 89 had intraoperative measurements available. CONTROL included 165 patients who underwent screening CTA for calcium scoring. In order to explore how CA corresponds to cusp geometry, correlations between CA and ratios of intraoperative measurements, including free margin length (FML) ratio and geometric height (GH) were analyzed. Each ratio was defined as the smallest cusp divided by the sum of all three cusps.
Results: CA was symmetric (smallest CA of 111 – 120°) in only about half of the patients: 87 patients (52.7%) in CONTROL and 65 patients (49.2%) in ANEURYSM. In ANEURYSM, 2 patients (1.5%) had very asymmetric CA (smallest CA of <100°). CA (degree) had no correlation with the size of sinus (r=-0.11, p=0.016 in CONTROL, r=-0.03, p=0.58 in ANEURYSM). The smallest CA was in left (aneurysm 57.6% vs. control 61.2%), non (34.9% vs. 37.6%), and right (7.6% vs. 1.2%), which was concordant with CT-measured GH and FML in only 57% and 71% of the patients, respectively. The coaptation point did not match with the center of the circle, with a larger deviation in aneurysm group (1.9 ± 1.1mm vs. 1.3 ± 0.6mm in the control group (P<0.001), suggesting an asymmetric coaptation pattern of cusps. Furthermore, degree of smallest CA was not associated with the corresponding ratios of FML or GH measured during VSRR (ratios of FML: r=0.17, p =0.11, GH: r=-0.20, p=0.062).
Conclusions: CA is frequently asymmetric in TAV and may be very asymmetric in aneurysm patients. Cusp coaptation occurs in an asymmetric fashion. CA may not be understood with intraoperative cusp measurement.
Authors
Yuichiro Kitada (1), Nasim Azizgolshani (2), Jack Nickles (3), Marco Tagliafierro (4), Adham Elmously (5), Yanling Zhao (6), Paul Kurlansky, MD (7), Isaac George (8), Andrew Goldstone (2), Hiroo Takayama (2)
Institutions
(1) New York Presbyterian Hospital/Columbia University Irving Medical Center, United States, NY, (2) NewYork- Presbyterian/Columbia University Medical Center, New York, NY, (3) N/A, N/A, (4) Columbia Univeristy Irving Medical Center, New York, NY, (5) N/A, New York, NY, (6) NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (7) Columbia University Medical Center, Fort Lee, NJ, (8) NYPH-Columbia University Medical Center, New York, NY
Methods: EKG-gated CTAs obtained in diastole phase were analyzed with 3D reconstruction software. A virtual circle was formed by connecting the three commissural peaks. CA was defined as the angle between each commissure and the circle's center. Coaptation point was defined as the junction of the free margins of all three cusps. Of 132 patients with mild or less AR who underwent VSRR for root aneurysm (ANEURYSM), 89 had intraoperative measurements available. CONTROL included 165 patients who underwent screening CTA for calcium scoring. In order to explore how CA corresponds to cusp geometry, correlations between CA and ratios of intraoperative measurements, including free margin length (FML) ratio and geometric height (GH) were analyzed. Each ratio was defined as the smallest cusp divided by the sum of all three cusps.
Results: CA was symmetric (smallest CA of 111 – 120°) in only about half of the patients: 87 patients (52.7%) in CONTROL and 65 patients (49.2%) in ANEURYSM. In ANEURYSM, 2 patients (1.5%) had very asymmetric CA (smallest CA of <100°). CA (degree) had no correlation with the size of sinus (r=-0.11, p=0.016 in CONTROL, r=-0.03, p=0.58 in ANEURYSM). The smallest CA was in left (aneurysm 57.6% vs. control 61.2%), non (34.9% vs. 37.6%), and right (7.6% vs. 1.2%), which was concordant with CT-measured GH and FML in only 57% and 71% of the patients, respectively. The coaptation point did not match with the center of the circle, with a larger deviation in aneurysm group (1.9 ± 1.1mm vs. 1.3 ± 0.6mm in the control group (P<0.001), suggesting an asymmetric coaptation pattern of cusps. Furthermore, degree of smallest CA was not associated with the corresponding ratios of FML or GH measured during VSRR (ratios of FML: r=0.17, p =0.11, GH: r=-0.20, p=0.062).
Conclusions: CA is frequently asymmetric in TAV and may be very asymmetric in aneurysm patients. Cusp coaptation occurs in an asymmetric fashion. CA may not be understood with intraoperative cusp measurement.
Authors
Yuichiro Kitada (1), Nasim Azizgolshani (2), Jack Nickles (3), Marco Tagliafierro (4), Adham Elmously (5), Yanling Zhao (6), Paul Kurlansky, MD (7), Isaac George (8), Andrew Goldstone (2), Hiroo Takayama (2)
Institutions
(1) New York Presbyterian Hospital/Columbia University Irving Medical Center, United States, NY, (2) NewYork- Presbyterian/Columbia University Medical Center, New York, NY, (3) N/A, N/A, (4) Columbia Univeristy Irving Medical Center, New York, NY, (5) N/A, New York, NY, (6) NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (7) Columbia University Medical Center, Fort Lee, NJ, (8) NYPH-Columbia University Medical Center, New York, NY
Presentation Duration
There is no formal presentation for posters. Your poster will be on display on your assigned day from 9:00AM - 4:00PM
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ADULT CARDIAC
Aortic Valve