Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis Having Coronary Cusp Fusion versus Mixed Cusp Fusion Nonraphe Bicuspid Aortic Valve. (3rd November 2019)

• Record Type: Journal Article
• Authors: Lei, Wen-hua; Liao, Yan-biao; Wang, Zi-jie; Ou, Yuan-weixiang; Tsauo, Jiay-yu; Li, Yi-jian; Xiong, Tian-yuan; Zhao, Zhen-gang; Wei, Xin; Meng, Wei; Feng, Yuan; Chen, Mao
• Other Names: Swaans Martin J. Academic Editor.
• Is Part Of: Journal of interventional cardiology. Volume 2019(2019)
• Publication Date: 2019-11-03
• Subjects: Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.1206
• DOI: 10.1155/2019/7348964
• Languages: English
• ISSNs: 0896-4327

Abstract

Abstract : Objectives . We aimed to assess the procedural and clinical results of transcatheter aortic valve replacement (TAVR) for nonraphe bicuspid aortic stenosis (AS) with coronary vs mixed cusp fusion. Background . It remains unclear whether cusp fusion morphology affects TAVR outcomes in patients with nonraphe bicuspid AS. Methods . This retrospective study enrolled consecutive patients with severe symptomatic AS and type-0 bicuspid aortic valve, who underwent TAVR at our institution between 2012 and 2017. TAVR outcomes were defined based on the Valve Academic Research Consortium-2 recommendations. Results . Compared to patients with mixed cusp fusion (44/71), those with coronary cusp fusion (27/71) had a larger ellipticity index for the aortic annulus (21.9% ± 9.0% vs 15.6% ± 9.3%, p = 0.007 ) and increased left ventricular outflow tract obstruction (31.1% ± 9.4% vs 26.9% ± 7.5%, p = 0.04 ) but comparable rates of second valve implantation (15.9% vs 14.8%), mild paravalvular leakage (PVL, 38.5% vs 30.2%), permanent pacemaker implantation (PPM, 25.9% vs 15.9%), and 30-day mortality (7.4% vs 6.8%). Use of a first-generation transcatheter heart valve was associated with higher risk for mild PVL (odds ratio (OR) = 4.37; 95% confidence interval (95% CI) = 1.14–16.75; p = 0.03 ) but not PPM (OR = 0.77; 95% CI = 0.22–2.62; p = 0.67 ), whereas a larger oversizing ratio tended to be associated with a higher PPM rate (OR = 1.49; 95% CI = 0.46–4.86; p = 0.51 ) but lower incidence of mild PVL (OR = 0.51; 95% CI = 0.19–1.35; p = 0.17 ). Conclusions . In AS patients with type-0 bicuspid valves, cusp fusion morphology does not affect the procedural or clinical results of TAVR. Use of second-generation transcatheter heart valves may provide more favorable results in such patients. This trial is registered with NCT01683474 .