TAVI in bicuspid aortic valves using CoreValve resulted in a higher post-procedural mean pressure gradient compared to tricuspid valves (11.0 vs. 8.2 mm Hg, P=0.04) and valve underexpansion.
Observational (n=67)
Does TAVI in bicuspid aortic valves result in different post-procedural MSCT characteristics and hemodynamics compared to tricuspid aortic valves?
TAVI in bicuspid aortic valves using CoreValve is associated with higher post-procedural gradients and valve underexpansion compared to tricuspid aortic valves.
Absolute Event Rate: 11% vs 8.2%
p-value: p=0.04
AIMS: This study sought to compare the multislice computed tomography (MSCT) characteristics of bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV) before and after implantation of the CoreValve (Medtronic, Santa Rosa, California) or the Edwards SapienXT (Edwards Lifesciences, Irvine, CA). METHODS AND RESULTS: From March 2009 to March 2013, a total of 67 TAVI patients who had both pre- and post-procedural MSCT were studied. Eleven patients underwent TAVI in BAV with the CoreValve (n = 6) or SapienXT (n = 5) and 56 patients underwent TAVI in TAV with the CoreValve (n = 38) or SapienXT (n = 18). The BAV group was similar to the TAV group except for a higher pre-procedural mean pressure gradient (53.1 ± 17.4 vs. 48.8 ± 20.4 mm Hg, P = 0.03), a larger annulus perimeter (89.3 ± 9.0 vs. 81.8 ± 8.1 mm, P = 0.03) and a higher aortic valve calcium volume (1262.7 ± 396.0 vs. 556.4 ± 461.9 mm(3) , P < 0.01). In the CoreValve group, post-procedural mean pressure gradient was significantly higher in the BAV group (11.0 ± 2.6 vs. 8.2 ± 2.8 mm Hg, P = 0.04) and a smaller valve area/pre-annulus area ratio was observed at each level of the prosthesis (base of the stent frame 81.7% ± 14.9% vs. 94.7% ± 15.0%, P = 0.06, annulus level 74.3% ± 16.7% vs. 89.9% ± 10.5%, P = 0.03, leaflet level 64.6% ± 13.1% vs. 81.2% ± 13.2%, P < 0.01). This was not observed in the Edwards group. CONCLUSIONS: Compared to TAV, patients with BAV have higher gradients, larger annulus perimeters and more calcified valves. Higher post procedural gradient and valve underexpansion were frequently observed after CoreValve implantation. Further MSCT study is required to demonstrate the efficacy of TAVI in BAV.
Watanabe et al. (Fri,) conducted a observational in Aortic valve disease requiring TAVI (n=67). TAVI in bicuspid aortic valves (BAV) vs. TAVI in tricuspid aortic valves (TAV) was evaluated on Post-procedural mean pressure gradient (CoreValve group) (p=0.04). TAVI in bicuspid aortic valves using CoreValve resulted in a higher post-procedural mean pressure gradient compared to tricuspid valves (11.0 vs. 8.2 mm Hg, P=0.04) and valve underexpansion.