Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease.

Mylotte, Darren; Lefevre, Thierry; Søndergaard, Lars; Watanabe, Yusuke; Modine, Thomas; Dvir, Danny; Bosmans, Johan; Tchetche, Didier; Kornowski, Ran; Sinning, Jan-Malte; Thériault-Lauzier, Pascal; O'Sullivan, Crochan J; Barbanti, Marco; Debry, Nicolas; Buithieu, Jean; Codner, Pablo; Dorfmeister, Magdalena; Martucci, Giuseppe; Nickenig, Georg; Wenaweser, Peter Martin; ... (2014). Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease. Journal of the American College of Cardiology, 64(22), pp. 2330-2339. Elsevier 10.1016/j.jacc.2014.09.039

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BACKGROUND

Limited information exists describing the results of transcatheter aortic valve (TAV) replacement in patients with bicuspid aortic valve (BAV) disease (TAV-in-BAV).

OBJECTIVES

This study sought to evaluate clinical outcomes of a large cohort of patients undergoing TAV-in-BAV.

METHODS

We retrospectively collected baseline characteristics, procedural data, and clinical follow-up findings from 12 centers in Europe and Canada that had performed TAV-in-BAV.

RESULTS

A total of 139 patients underwent TAV-in-BAV with the balloon-expandable transcatheter heart valve (THV) (n = 48) or self-expandable THV (n = 91) systems. Patient mean age and Society of Thoracic Surgeons predicted risk of mortality scores were 78.0 ± 8.9 years and 4.9 ± 3.4%, respectively. BAV stenosis occurred in 65.5%, regurgitation in 0.7%, and mixed disease in 33.8% of patients. Incidence of type 0 BAV was 26.7%; type 1 BAV was 68.3%; and type 2 BAV was 5.0%. Multislice computed tomography (MSCT)-based TAV sizing was used in 63.5% of patients (77.1% balloon-expandable THV vs. 56.0% self-expandable THV, p = 0.02). Procedural mortality was 3.6%, with TAV embolization in 2.2% and conversion to surgery in 2.2%. The mean aortic gradient decreased from 48.7 ± 16.5 mm Hg to 11.4 ± 9.9 mm Hg (p < 0.0001). Post-implantation aortic regurgitation (AR) grade ≥2 occurred in 28.4% (19.6% balloon-expandable THV vs. 32.2% self-expandable THV, p = 0.11) but was prevalent in only 17.4% when MSCT-based TAV sizing was performed (16.7% balloon-expandable THV vs. 17.6% self-expandable THV, p = 0.99). MSCT sizing was associated with reduced AR on multivariate analysis (odds ratio [OR]: 0.19, 95% confidence intervals [CI]: 0.08 to 0.45; p < 0.0001). Thirty-day device safety, success, and efficacy were noted in 79.1%, 89.9%, and 84.9% of patients, respectively. One-year mortality was 17.5%. Major vascular complications were associated with increased 1-year mortality (OR: 5.66, 95% CI: 1.21 to 26.43; p = 0.03).

CONCLUSIONS

TAV-in-BAV is feasible with encouraging short- and intermediate-term clinical outcomes. Importantly, a high incidence of post-implantation AR is observed, which appears to be mitigated by MSCT-based TAV sizing. Given the suboptimal echocardiographic results, further study is required to evaluate long-term efficacy.

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