Journal article
Transcatheter aortic valve replacement in bicuspid aortic valve disease.
- Mylotte D Department of Cardiology, University Hospital Galway, Galway, Ireland; Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
- Lefevre T Department of Interventional Cardiology, Hopital Jacques Cartier, Massy, France.
- Søndergaard L Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
- Watanabe Y Department of Interventional Cardiology, Hopital Jacques Cartier, Massy, France.
- Modine T Department of Cardiovascular Surgery, Hôpital Cardiologique, Lille, France.
- Dvir D Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
- Bosmans J Department of Cardiology, University Hospital Antwerp, Wilrijk, Belgium.
- Tchetche D Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France.
- Kornowski R Department of Cardiology, Rabin Medical Center and Tel-Aviv University, Tel-Aviv, Israel.
- Sinning JM Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Interventional Cardiology, Hopital Jacques Cartier, Massy, France.
- Thériault-Lauzier P Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
- O'Sullivan CJ Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Barbanti M Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
- Debry N Department of Cardiovascular Surgery, Hôpital Cardiologique, Lille, France.
- Buithieu J Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
- Codner P Department of Cardiology, Rabin Medical Center and Tel-Aviv University, Tel-Aviv, Israel.
- Dorfmeister M Department of Cardiovascular Surgery, German Heart Center, Munich, Germany.
- Martucci G Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
- Nickenig G Department of Cardiology, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
- Wenaweser P Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Tamburino C Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
- Grube E Department of Cardiology, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
- Webb JG Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
- Windecker S Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Lange R Department of Cardiovascular Surgery, German Heart Center, Munich, Germany.
- Piazza N Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Cardiovascular Surgery, German Heart Center, Munich, Germany. Electronic address: nicolopiazza@mac.com.
- 2014-12-04
Published in:
- Journal of the American College of Cardiology. - 2014
aortic stenosis
aortic valve replacement
bicuspid aortic valve
transcatheter aortic valve implantation
transcatheter aortic valve replacement
Aged
Aged, 80 and over
Aortic Valve
Aortic Valve Stenosis
Cohort Studies
Female
Heart Valve Diseases
Humans
Male
Prospective Studies
Registries
Retrospective Studies
Transcatheter Aortic Valve Replacement
Treatment Outcome
English
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.
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.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.jacc.2014.09.039
- PMID 25465419
- Persistent URL
- https://sonar.ch/global/documents/169626
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