C De Biase1, A Mastrokostopoulos2, R Philippart2, L M Desroche2, S Blanco2, K Rehal2, N Dumonteil2, D Tchetche3. 1. Groupe Cardiovasculaire Interventionel (GCVI), Clinique Pasteur, Toulouse, France. Electronic address: chiadebiase@gmail.com. 2. Groupe Cardiovasculaire Interventionel (GCVI), Clinique Pasteur, Toulouse, France. 3. Groupe Cardiovasculaire Interventionel (GCVI), Clinique Pasteur, Toulouse, France. Electronic address: dtchetche@clinique-pasteur.com.
Abstract
PURPOSE: Aortic stenosis (AS) in bicuspid aortic valve (BAV) remains a challenge for transcatheter aortic valve implantation (TAVI). BAV is a condition encountered in young adults as well as elderly patients. Frequently we face in clinical practice elderly patients with BAV and severe AS, but there is little evidence concerning TAVI in this population. The aim of our study was to compare anatomic features and outcomes of bicuspid and tricuspid patients with AS undergoing TAVI. METHODS: 83 consecutive BAV patients undergoing TAVI were matched, in a 1:2 ratio, to 166 tricuspid patients. Multi-detector computed tomography (MDCT) and transthoracic echocardiogram (TTE) were assessed at baseline. Primary endpoint was all-cause mortality and early safety at 30 days according to Valve Academic Research Consortium criteria 2 (VARC-2). Secondary endpoint included device success. RESULTS: BAV patients presented more aortic root calcifications, smaller diameter of left ventricular outflow tract (LVOT) and dilated aorta. We did not observe any statistically significant difference concerning all-cause mortality and early safety at 30 days. However higher intra-procedural TAV-in-TAV bailout procedure was observed in the BAV cohort, with consequent reduction of device success rate. CONCLUSIONS: Patients with BAV present more complex anatomy at baseline as compared to tricuspid AS patients. These anatomical features lead to more frequent TAV-in-TAV bailout procedure and lower device success rate, but are not associated with higher mortality rate at 30 days. Our findings support the feasibility of TAVI in BAV, but larger studies with longer follow-up and a focus on sizing are required.
PURPOSE:Aortic stenosis (AS) in bicuspid aortic valve (BAV) remains a challenge for transcatheter aortic valve implantation (TAVI). BAV is a condition encountered in young adults as well as elderly patients. Frequently we face in clinical practice elderly patients with BAV and severe AS, but there is little evidence concerning TAVI in this population. The aim of our study was to compare anatomic features and outcomes of bicuspid and tricuspid patients with AS undergoing TAVI. METHODS: 83 consecutive BAV patients undergoing TAVI were matched, in a 1:2 ratio, to 166 tricuspid patients. Multi-detector computed tomography (MDCT) and transthoracic echocardiogram (TTE) were assessed at baseline. Primary endpoint was all-cause mortality and early safety at 30 days according to Valve Academic Research Consortium criteria 2 (VARC-2). Secondary endpoint included device success. RESULTS: BAV patients presented more aortic root calcifications, smaller diameter of left ventricular outflow tract (LVOT) and dilated aorta. We did not observe any statistically significant difference concerning all-cause mortality and early safety at 30 days. However higher intra-procedural TAV-in-TAV bailout procedure was observed in the BAV cohort, with consequent reduction of device success rate. CONCLUSIONS:Patients with BAV present more complex anatomy at baseline as compared to tricuspid AS patients. These anatomical features lead to more frequent TAV-in-TAV bailout procedure and lower device success rate, but are not associated with higher mortality rate at 30 days. Our findings support the feasibility of TAVI in BAV, but larger studies with longer follow-up and a focus on sizing are required.
Authors: Piotr A Chodór; Krzysztof Wilczek; Karolina Chodór-Rozwadowska; Roman Przybylski; Jan Głowacki; Tomasz Niklewski; Łukasz Włoch; Mariusz Gąsior; Marian Zembala; Zbigniew Kalarus Journal: Postepy Kardiol Interwencyjnej Date: 2021-03-27 Impact factor: 1.426