THV deformation post-TAVR and excess raphe/leaflet calcification were associated with significantly higher 3-year all-cause mortality (32.3% vs 7.9% for excess calcification, p=0.015).
Cohort (n=229)
Does transcatheter heart valve deformation and severe calcification increase mortality and leaflet thrombosis in patients with bicuspid aortic valves undergoing TAVR?
In patients with bicuspid aortic valves undergoing TAVR, post-procedural valve deformation and specific calcification patterns (annulus, LVOT, raphe) are significant predictors of 3-year mortality and leaflet thrombosis.
Abstract Background Research on the role of transcatheter heart valve (THV) deformation and calcium distribution in patients with bicuspid aortic valve (BAV) undergoing transcatheter aortic valve replacement (TAVR) remains limited. Purpose We aimed to evaluate the impact of THV deformation on clinical outcomes in individuals with BAV undergoing TAVR and the influence of calcium on these outcomes. Methods We analyzed 229 consecuive patients with BAV who underwent TAVR with balloon-expandable valves received 30 days post-TAVR. Patients were categorized into groups based on post-procedural THV deformation: group 1 (n=125) with no THV under-expansion or eccentricity, group 2 (n=69) with under-expansion or eccentricity, and group 3 (n=35) with both. Calcium distribution was assessed using computed tomography, and its association with clinical outcomes, including all-cause mortality at 3 years and hypoattenuated leaflet thickening (HALT) at 30 days, was determined. A subgroup analysis of patients with type 1 BAV was conducted. Results No significant differences were noted in the type of BAV, coronary height, or grade of STJ calcification between the groups. In contrast, group 3 showed a higher severity of annulus and left ventricular outflow tract (LVOT) calcification than the other groups (p0.001). Group 3 demonstrated a significantly higher rate of all-cause mortality and the composite outcome of all-cause mortality, hospitalization owing to heart failure, or stroke at 3 years than groups 1 and 2 (Figure 1). The prevalence of HALT at 30 days was significantly higher in group 3 than in the other groups (Figure 2). The occurrence of mild to severe PVL at 30 days post-TAVR was more prevalent in group 3 than in the other two groups (20.0% vs. 24.6% vs. 31.4% for groups 1, 2, and 3, respectively; p=0.046). However, no significant differences were observed between the groups in aortic valve area or mean pressure gradient at 30 days post-TAVR. Multivariable Cox proportional hazards analysis identified age and moderate or severe annulus/LVOT calcifications as predictors of all-cause mortality. In type 1 BAV patients, patients with both excess raphe and opposite leaflet calcifications had significantly higher rates of all-cause mortality at 3 years than those without excess raphe and opposite leaflet calcifications (32.3% vs. 7.9%, respectively; log-rank p=0.015). Conclusions THV deformation post-TAVR was significantly linked to all-cause mortality in patients with BAV. Annulus and LVOT calcification correlated with increased risks of all-cause mortality and leaflet thrombosis. Calcification of the raphe and opposite leaflet emerged as a risk factor for adverse TAVR outcomes. Therefore, pre-procedural assessment of calcium distribution using MDCT is warranted to optimize patient care and improve TAVR clinical outcomes in BAV patients.Clinical outcomes at 3 years after TAVR Evaluation of HALT
Nagasaka et al. (Sat,) conducted a cohort in Bicuspid aortic valve (BAV) undergoing transcatheter aortic valve replacement (TAVR) (n=229). THV deformation (under-expansion and eccentricity) and severe calcification vs. No THV deformation or severe calcification was evaluated on All-cause mortality at 3 years and hypoattenuated leaflet thickening (HALT) at 30 days. THV deformation post-TAVR and excess raphe/leaflet calcification were associated with significantly higher 3-year all-cause mortality (32.3% vs 7.9% for excess calcification, p=0.015).