Supra-annular sizing of transcatheter aortic valve prostheses in raphe-type bicuspid aortic valve disease: the LIRA method

Background: Recent evidence shows that THV prostheses anchoring occurs at the raphe-level, known as LIRA plane, in raphe-type bicuspid aortic valve (BAV) disease. The purpose of this study was to evaluate the application of a novel supra-annular sizing method, known as Level of Implantation at the RAphe (LIRA) method, to optimize transcatheter heart valve (THV) prosthesis sizing in raphe-type BAV disease. Methods and results: The LIRA method was applied to all consecutive patients with raphe-type BAV disease between November 2018 to January 2020 in our centre. THV prostheses were sized on the basis of baseline CT scan perimeters at the LIRA plane and at the virtual basal ring. In case of discrepancy between the two plane measurements, the plane with the smallest perimeter was considered the reference for prosthesis sizing. Post-procedural device success, defined according to Valve Academic Research Consortium–2 (VARC-2) criteria, was evaluated in the overall cohort. 20 patients (mean patient age 81 ± 5.4 years, 70% males) were identified as having a raphe-type BAV disease at pre-procedural CT scans and were implanted with different types of THV prostheses. The LIRA plane method appeared to be highly successful (100% VARC-2 device success) with no procedural mortality, no valve migration, no moderate-severe paravalvular leak and low transprosthetic gradient (residual mean gradient of 8.2 ± 2.9 mm Hg). Conclusions: Supra-annular sizing according to the LIRA method appeared to be safe with a high device success. The application of the LIRA method might optimize THV prosthesis sizing in patients with raphe-type BAV disease.