Bicuspid Aortic Valve Morphology and Outcomes After Transcatheter Aortic Valve Replacement.

Yoon, Sung-Han; Kim, Won-Keun; Dhoble, Abhijeet; Milhorini Pio, Stephan; Babaliaros, Vasilis; Jilaihawi, Hasan; Pilgrim, Thomas; De Backer, Ole; Bleiziffer, Sabine; Vincent, Flavien; Shmidt, Tobias; Butter, Christian; Kamioka, Norihiko; Eschenbach, Lena; Renker, Matthias; Asami, Masahiko; Lazkani, Mohamad; Fujita, Buntaro; Birs, Antoinette; Barbanti, Marco; ... (2020). Bicuspid Aortic Valve Morphology and Outcomes After Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology, 76(9), pp. 1018-1030. Elsevier 10.1016/j.jacc.2020.07.005

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BACKGROUND

Bicuspid aortic stenosis accounts for almost 50% of patients undergoing surgical aortic valve replacement in the younger patients. Expanding the indication of transcatheter aortic valve replacement (TAVR) toward lower-risk and younger populations will lead to increased use of TAVR for patients with bicuspid aortic valve (BAV) stenosis despite the exclusion of bicuspid anatomy in all pivotal clinical trials.

OBJECTIVES

This study sought to evaluate the association of BAV morphology and outcomes of TAVR with the new-generation devices.

METHODS

Patients with BAV confirmed by central core laboratory computed tomography (CT) analysis were included from the international multicenter BAV TAVR registry. BAV morphology including the number of raphe, calcification grade in raphe, and leaflet calcium volume were assessed with CT analysis in a masked fashion. Primary outcomes were all-cause mortality at 1 and 2 years, and secondary outcomes included 30-day major endpoints and procedural complications.

RESULTS

A total of 1,034 CT-confirmed BAV patients with a mean age of 74.7 years and Society of Thoracic Surgeons score of 3.7% underwent TAVR with contemporary devices (n = 740 with Sapien 3; n = 188 with Evolut R/Pro; n = 106 with others). All-cause 30-day, 1-year, and 2-year mortality was 2.0%, 6.7%, and 12.5%, respectively. Multivariable analysis identified calcified raphe and excess leaflet calcification (defined as more than median calcium volume) as independent predictors of 2-year all-cause mortality. Both calcified raphe plus excess leaflet calcification were found in 269 patients (26.0%), and they had significantly higher 2-year all-cause mortality than those with 1 or none of these morphological features (25.7% vs. 9.5% vs. 5.9%; log-rank p < 0.001). Patients with both morphological features had higher rates of aortic root injury (p < 0.001), moderate-to-severe paravalvular regurgitation (p = 0.002), and 30-day mortality (p = 0.016).

CONCLUSIONS

Outcomes of TAVR in bicuspid aortic stenosis depend on valve morphology. Calcified raphe and excess leaflet calcification were associated with increased risk of procedural complications and midterm mortality. (Bicuspid Aortic Valve Stenosis Transcatheter Aortic Valve Replacement Registry; NCT03836521).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Pilgrim, Thomas and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0735-1097

Publisher:

Elsevier

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

25 Nov 2020 11:06

Last Modified:

25 Nov 2020 16:21

Publisher DOI:

10.1016/j.jacc.2020.07.005

PubMed ID:

32854836

Uncontrolled Keywords:

aortic stenosis bicuspid aortic valve transcatheter aortic valve implantation

BORIS DOI:

10.7892/boris.147464

URI:

https://boris.unibe.ch/id/eprint/147464

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