Aortic valve anatomy and outcomes after transcatheter aortic valve implantation in bicuspid aortic valves. (1st September 2018)

• Record Type: Journal Article
• Authors: De Biase, C.; Mastrokostopoulos, A.; Philippart, R.; Desroche, L.M.; Blanco, S.; Rehal, K.; Dumonteil, N.; Tchetche, D.
• Is Part Of: International journal of cardiology. Volume 266(2018)
• Page Start: 56
• Page End: 60
• Publication Date: 2018-09-01
• Subjects: AR aortic regurgitation -- AS aortic stenosis -- BAV bicuspid aortic valve(s) -- CABG coronary artery bypass grafting -- COPD chronic obstructive pulmonary disease -- ER Medtronic Evolut R -- LVOT left ventricular outflow tract -- MI myocardial infarction -- MDCT multi-detector computed tomography -- NYHA New York Heart Association -- PCI percutaneous coronary intervention -- PPM prosthesis-patient mismatch -- PVL para-valvular leak -- S3 Edwards Sapien 3 -- STS Society of Thoracic Surgery -- TAVI transcatheter aortic valve implantation -- TAV-in-TAV transcatheter aortic valve in transcatheter aortic valve -- TTE transthoracic echocardiogram -- VARC 2 Valve Academic Research Consortium criteria 2; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.01.018
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Purpose: Aortic stenosis (AS) in bicuspid aortic valve (BAV) remains a challenge for transcatheter aortic valve implantation (TAVI). BAV is a condition encountered in young adults as well as elderly patients. Frequently we face in clinical practice elderly patients with BAV and severe AS, but there is little evidence concerning TAVI in this population. The aim of our study was to compare anatomic features and outcomes of bicuspid and tricuspid patients with AS undergoing TAVI. Methods: 83 consecutive BAV patients undergoing TAVI were matched, in a 1:2 ratio, to 166 tricuspid patients. Multi-detector computed tomography (MDCT) and transthoracic echocardiogram (TTE) were assessed at baseline. Primary endpoint was all-cause mortality and early safety at 30 days according to Valve Academic Research Consortium criteria 2 (VARC-2). Secondary endpoint included device success. Results: BAV patients presented more aortic root calcifications, smaller diameter of left ventricular outflow tract (LVOT) and dilated aorta. We did not observe any statistically significant difference concerning all-cause mortality and early safety at 30 days. However higher intra-procedural TAV-in-TAV bailout procedure was observed in the BAV cohort, with consequent reduction of device success rate. Conclusions: Patients with BAV present more complex anatomy at baseline as compared to tricuspid AS patients. These anatomical features lead to more frequent TAV-in-TAV bailout procedure and lower device success rate, but are not associated with higher mortality rate at 30 days. Our findings support the feasibility of TAVI in BAV, but larger studies with longer follow-up and a focus on sizing are required. Graphical abstract: Highlights: Our study aims to compare bicuspid and tricuspid patients with AS undergoing TAVI. 83 BAV patients undergoing TAVI were matched to 166 tricuspid patients (1:2 ratio). Endpoints were all-cause mortality, early safety and device success rate. No statistically significant difference for mortality and early safety was observed. Higher intra-procedural TAV-in-TAV bailout procedure was observed in the BAV cohort.