Transfemoral TAVR resulted in similar rates of ≥mild paravalvular leakage in propensity-matched patients with bicuspid versus tricuspid aortic valves (51.9% vs. 51.7%; P=0.955).
Cohort (n=2,394)
No
Does the incidence and mechanism of paravalvular leakage differ between bicuspid and tricuspid aortic stenosis patients undergoing transfemoral TAVR with new-generation devices?
The incidence and predictors of paravalvular leakage following TAVR with new-generation devices are similar between patients with bicuspid and tricuspid aortic stenosis, suggesting a common underlying mechanism.
Absolute Event Rate: 51.9% vs 51.7%
p-value: p=0.955
AIMS: Paravalvular leakage (PVL) after transcatheter aortic valve replacement (TAVR) is a common complication in patients with bicuspid aortic valve (BAV). However, predictors and mechanisms of PVL are not well understood in this subset. The aim of this study was to analyse determinants and mechanisms of PVL in BAV and tricuspid aortic valve (TAV). METHODS AND RESULTS: Of the 2394 consecutive patients undergoing transfemoral TAVR using new-generation valves at our centre, we identified 242 cases with BAV. To adjust for baseline differences, we performed 3 : 1 propensity score matching (TAVPS n = 726). We analysed the aortic root anatomy and calcification as well as the number, circumferential distribution, and predilection sites of PVL using pre-procedural multidetector computed tomography and post-TAVR echocardiography. In the matched cohort, the incidence of PVL ≥mild (BAV 51.9% vs. TAVPS 51.7%; P = 0.955) and PVL ≥moderate (BAV 5.0% vs. TAVPS 3.7%; P = 0.393), the circumferential distribution, and independent predictors were similar between BAV and TAVPS. Both the presence of peri-annular calcium chunks or LVOT calcification were highly associated with PVL in BAV and TAVPS patients, whereas in BAV patients neither the presence of a calcium bridge nor the volume of its calcification was related to PVL. Notably, the spatial localization of these lesions did not necessarily match the circumferential leak position. CONCLUSION: The incidence, circumferential distribution, predilection sites, and predictors of PVL were similar in matched population of BAV and TAVPS patients undergoing transfemoral TAVR using new-generation devices. These novel findings suggest a common underlying mechanism of PVL in both entities.
Kim et al. (Thu,) conducted a cohort in Bicuspid and tricuspid aortic stenosis (n=2,394). Transfemoral TAVR in bicuspid aortic valve vs. Transfemoral TAVR in tricuspid aortic valve was evaluated on Incidence of paravalvular leakage ≥mild (p=0.955). Transfemoral TAVR resulted in similar rates of ≥mild paravalvular leakage in propensity-matched patients with bicuspid versus tricuspid aortic valves (51.9% vs. 51.7%; P=0.955).