What is the clinical evidence from this study?

Study design: Other. Population: bicuspid aortic valve stenosis (n=150). Intervention: Transcatheter aortic valve replacement (Evolut or Evolut PRO). Primary outcome: all-cause mortality or disabling stroke at 30 days (95% CI 0.3%-5.3%).

October 7, 2020Open Access

Transcatheter Aortic Valve Replacement in Low-risk Patients With Bicuspid Aortic Valve Stenosis

Resultado clave

Transcatheter aortic valve replacement in low-risk patients with bicuspid aortic stenosis resulted in a 1.3% rate of all-cause mortality or disabling stroke at 30 days.

PICO estructurado

Does transcatheter aortic valve replacement (TAVR) achieve favorable procedural and 30-day outcomes in low-risk patients with bicuspid aortic valve stenosis?

Población

150 patients with severe bicuspid aortic valve stenosis at low surgical risk (mean STS score 1.4%), mean age 70.3 years, 48.0% female, across 25 centers in the United States. Key inclusion: severe symptomatic aortic stenosis (aortic valve area ≤1.0 cm2 or mean gradient ≥40 mm Hg) or asymptomatic meeting AHA/ACC class IIa criteria for AVR, with predicted 30-day mortality risk <3.0%.

Intervención

Transcatheter aortic valve replacement (TAVR) using Evolut R or Evolut PRO self-expanding transcatheter aortic valves, with valve size based on annular measurements.

Resultado

Incidence of all-cause mortality or disabling stroke at 30 days (primary safety); device success defined as the absence of procedural mortality, correct position of 1 bioprosthetic heart valve in the proper anatomical location, and absence of more than mild aortic regurgitation postprocedure (primary efficacy).composite

Transcatheter aortic valve replacement in low-surgical risk patients with bicuspid aortic valve stenosis is safe and effective at 30 days, achieving high device success and low rates of death or disabling stroke.

Resumen

Importance: The outcomes of transcatheter aortic valve replacement (TAVR) in low-risk patients with bicuspid aortic valve stenosis have not been studied in a large scale, multicentered, prospective fashion. Objective: To evaluate the procedural safety, efficacy, and 30-day outcomes of TAVR in patients with bicuspid aortic stenosis at low surgical risk. Design, Setting, and Participants: The Low Risk Bicuspid Study is a prospective, single-arm trial study with inclusion/exclusion criteria developed from the Evolut Low Risk Randomized Trial. Follow-up is planned for 10 years. Patients underwent TAVR at 25 centers in the United States who were also participating in the Evolut Low Risk Randomized Trial from December 2018 to October 2019. Eligible patients had severe bicuspid aortic valve stenosis and met American Heart Association/American College of Cardiology guideline indications for aortic valve replacement. Interventions: Patients underwent attempted implant of an Evolut or Evolut PRO transcatheter aortic valve, with valve size based on annular measurements. Main Outcomes and Measures: The prespecified primary end point was the incidence of all-cause mortality or disabling stroke at 30 days. The prespecified primary efficacy end point was device success defined as the absence of procedural mortality, the correct position of 1 bioprosthetic heart valve in the proper anatomical location, and the absence of more than mild aortic regurgitation postprocedure. Results: A total of 150 patients underwent an attempted implant. Baseline characteristics include mean age of 70.3 (5.5) years, 48.0% female (n = 72), and a mean Society of Thoracic Surgeons score of 1.4 (0.6%). Most patients (136; 90.7%) had Sievers type I valve morphology. The incidence of all-cause mortality or disabling stroke was 1.3% (95% CI, 0.3%-5.3%) at 30 days. The device success rate was 95.3% (95% CI, 90.5%-98.1%). At 30 days, the mean (SD) AV gradient was 7.6 (3.7) mm Hg and effective orifice area was 2.3 (0.7) cm2. A new permanent pacemaker was implanted in 22 patients (15.1%). No patients had greater than mild paravalvular leak. Conclusions and Relevance: Transcatheter aortic valve replacement in low-surgical risk patients with bicuspid aortic valve stenosis achieved favorable 30-day results, with low rates of death and stroke and high device success rate. Trial Registration: ClinicalTrials.gov Identifier: NCT03635424.

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