Transcatheter aortic valve replacement in bicuspid aortic valve disease achieved an 89.9% 30-day device success rate, but post-implantation aortic regurgitation grade ≥2 occurred in 28.4%.
Cohort
Yes
Is transcatheter aortic valve replacement feasible and safe in patients with bicuspid aortic valve disease?
139 patients with bicuspid aortic valve (BAV) disease, mean age 78.0 ± 8.9 years, STS predicted risk of mortality score 4.9 ± 3.4%, from 12 centers in Europe and Canada.
Transcatheter aortic valve replacement (TAVR) using balloon-expandable (n=48) or self-expandable (n=91) transcatheter heart valve systems.
Clinical outcomes including procedural mortality, mean aortic gradient change, post-implantation aortic regurgitation (AR), 30-day device safety, success, and efficacy, and 1-year mortality.composite
TAVR is feasible in patients with bicuspid aortic valve disease but carries a high risk of post-implantation aortic regurgitation, which can be significantly mitigated by using MSCT-based valve sizing.
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.
“I do think we've developed a better understanding of aortic valve disease and anatomies that are conducive to transcatheter therapies, as well as anatomies not so conducive. What this study showed is that when you look at what's presently being done for patients with bicuspid aortic valve disease undergoing TAVR within the TVT registry, the outcomes are fairly similar to that of people who are getting TAVR for tricuspid aortic stenosis.”
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Darren Mylotte
Thierry Lefèvre
Lars Søndergaard
Journal of the American College of Cardiology
Tel Aviv University
University of Bern
University of Bonn
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Mylotte et al. (Mon,) conducted a cohort in Bicuspid aortic valve disease (n=139). Transcatheter Aortic Valve Replacement (TAVR) was evaluated on 30-day device success. Transcatheter aortic valve replacement in bicuspid aortic valve disease achieved an 89.9% 30-day device success rate, but post-implantation aortic regurgitation grade ≥2 occurred in 28.4%.
www.synapsesocial.com/papers/69ea8cc3afaea9b2b5270029 — DOI: https://doi.org/10.1016/j.jacc.2014.09.039