ArticleEuropean heart journal supplements : journal of the European Society of Cardiology2022
Update on supra-annular sizing of transcatheter aortic valve prostheses in raphe-type bicuspid aortic valve disease according to the LIRA method.
Article in European heart journal supplements : journal of the European Society of Cardiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06657911 (SUBLIME), which is not on this map. Cited by 9 papers.
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The trial behind it
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SUBLIME: Size Up Bicuspid With the LIra MEthod: the SUBLIME Study
Who cites it
9 citing papers in PubMed, 14 citations in OpenAlex.
- Seeing Beyond the Silhouette: Understanding Transcatheter Valve Mechanics in Bicuspid Aortic Stenosis.JACC. Case reports · 2026Article
- Ex Vivo Intravascular Ultrasound Assessment of Transcatheter Valve Deformation in Bicuspid Anatomy.JACC. Case reports · 2026Article
- Current Trends and Future Challenges in Transcatheter Aortic Valve Implantation (TAVI): A Narrative Review.Journal of clinical medicine · 2026Review
- Cardiovascular CT in Bicuspid Aortic Valve Disease: A State-of-the-Art Narrative Review of Advances, Clinical Integration, and Future Directions.Journal of clinical medicine · 2026Review
- Long-Term Durability of Transcatheter Aortic Valves in Patients With Bicuspid Aortic Stenosis.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025Article
- The ABC Bicuspid Sizing Protocol for SAPIEN 3 Balloon-Expandable Valves.Structural heart : the journal of the Heart Team · 2025Article
- TAVI with the ACURATE neo2 in severe bicuspid aortic valve stenosis: the Neo2 BAV Registry.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025Article
- Raphe-Type Bicuspid Aortic Valve as a Risk Factor for Transcatheter Aortic Valve Replacement Failure: Improving Outcomes Using the LIRA Method and the Medtronic FX Prosthesis.Journal of cardiovascular development and disease · 2024Article
- Transcatheter Aortic Valve Implantation for Bicuspid Aortic Valve Disease: Procedural Planning and Clinical Outcomes.Journal of clinical medicine · 2023Review
Corrections and comments
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Authors and funding
12 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Recent evidence has shown that transcatheter heart valve (THV) anchoring in bicuspid aortic valve (BAV) patients occurs at the level of the raphe, known as the LIRA (Level of Implantation at the RAphe) plane. Our previous work in a cohort of 20 patients has shown that the delineation of the perimeter and device sizing at this level is associated with optimal procedural outcome. The goals of this study were to confirm the feasibility of this method, evaluate 30-day outcomes of LIRA sizing in a larger cohort of patients, assess interobserver variation and reproducibility of this sizing methodology, and analyse the interaction of LIRA-sized prostheses with the surrounding anatomy. The LIRA sizing method was applied to consecutive patients presenting to our centre with raphe-type BAV disease between November 2018 and October 2021. Supra-annular self-expanding THVs were sized based on baseline CT scan perimeters at the LIRA plane and the virtual basal ring. In cases where there was discrepancy between the two 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. A total of 50 patients (mean age 80 ± 6 years, 70% male) with raphe-type BAV disease underwent transcatheter aortic valve replacement (TAVR) using different 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 gradients (residual mean gradient 8.2 ± 3.4 mmHg). There were no strokes, no in-hospital or 30-day mortality, and an incidence of in-hospital pacemaker implantation of 10%. Furthermore, measurement of the LIRA plane perimeter was highly reproducible between observers (
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