GW24-e1746 Transcatheter aortic valve implantation in high-risk patients with severe bicuspid aortic valve stenosis: Feasibility, safety and efficacy. (1st October 2013) - Mao, Chen
Abstract : Objectives: We sought to assess the feasibility and outcomes of transcatheter aortic valve implantation (TAVI) in the setting of bicuspid aortic valves (BAVs), which were regarded as a relative contraindication. Methods: Consecutive patients with severe BAV stenosis, who underwent TAVI at West China Hospital between April 2012 and March 2013, were included for analysis. Their procedural, hemodynamic and clinical outcomes were presented according to the standardised definitions of the Valvular Academic Research Consortium-2 (VARC-2). Results: A total of 12 patients (mean age, 73 years; 9 men and 3 women) with symptomatic BAV stenosis were identified. All patients were deemed unsuitable for conventional aortic valve replacement due to high perceived surgical risk, as was testified by the mean logistic EuroSCORE of 36.1%. TAVI was performed through a transfemoral and transsubclavian access in 11 and 1 patient, respectively. The Medtronic CoreValve was successfully implanted for all patients with the exception of one, in whom the prosthetic valve failed to expand properly due to the heavily calcified native leaflets and was retracted safely without adverse effects. There was no intraprocedural or periprocedural (within 72 hours following TAVI) death. Striking hemodynamic improvements were observed after TAVI. The mean (± standard deviation) aortic-valve gradient reduced from 57.7 ± 9.3 mmHg to 13.1 ± 5.4 mmHg, and the peak jet velocity decreased from 4.8 ± 0.5 m/s to 2.3 ± 0.6 m/s. Marginal moderate periprosthetic regurgitation occurred in 1 patient. Using the VARC-2 definition, the device success rate was 83.3% (10 of 12). Permanent pacemakers were implanted in 4 patients (33.3%) owing to third-degree atrioventricular blocks. One patient was attacked by ischaemic stroke 4 days after TAVI, but recovered without significant neurological sequelae at discharge. Another patient suffered from minor vascular complication (or minor bleeding) and died suddenly 20 days after TAVI. Afterwards, no further death was observed. Thus the survival rate was 91.7% at 30 days and remained unchanged at a median follow-up over 200 days to date. Conclusions: TAVI using the CoreValve is feasible, safe and associated with satisfactory mid-term clinical outcomes in selected high-risk patients with severely stenotic BAVs, but the long-term outcomes remain to be evaluated.