Tamunoinemi Bob-Manuel1, Mark R Heckle2, Ikechukwu A Ifedili2, Jiajing Wang3, Uzoma N Ibebuogu1. 1. Division of Cardiovascular Diseases, Ochsner Clinic Foundation, New Orleans, USA. 2. Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Memphis, USA. 3. Division of Biostatistics & Epidemiology, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA.
Abstract
BACKGROUND: Due to abnormal valve geometry, patients with bicuspid aortic valve (BAV) have been excluded in many transcatheter aortic valve replacement (TAVR) trials resulting in very limited data with regards to its safety and efficacy. METHODS: We searched electronic databases including Cochrane Database of Systematic Reviews, MEDLINE and EMBASE for all studies including case series, and original reports published before December 2018 that assessed outcomes following TAVR in BAV stenosis. We also included studies that had patients with TAV for comparison. Pooled effect size was calculated with a random-effect model and weighted for the inverse of variance, to compare outcomes post-TAVR between BAV and TAV. The heterogeneity of effect estimates across the studies was assessed using I2. Publication bias was assessed with funnel plots. Statistical analysis was performed using SPSS version 24 (IBM Corp., SPSS Statistics for Windows, Version 24.0. Armonk, NY.). RESULTS: A total of 19 studies describing 1,332 patients with BAV and 3,610 with TAV. There was no significant difference in the30-day mortality between patients with BAV and TAV [odds ratio (OR): 1.18, 95% confidence interval (CI): 0.7-1.7, P=0.41, I2=0]. One-year mortality rate in the BAV population was 13.1% compared to 15.4% in the TAV patients (P=0.75). Patients with BAV had significantly more moderate to severe paravalvular leak (PVL) post TAVR (PVL ≥3) 8.8% vs. 4.2% in TAV patients (OR: 1.478, 95% CI: 1.000-2.184, P=0.050, I2=0. Device success was significantly higher in TAV patients compared to BAV patients 93.5% vs. 87% (OR: 0.63, 95% CI: 0.49-0.86, P=0.003). CONCLUSIONS: TAVR in patients with BAV is associated with a high incidence of paravalvular regurgitation with a comparable 30-day mortality rate to TAV patients. The use of newer generation valve prosthesis improved outcomes.
BACKGROUND: Due to abnormal valve geometry, patients with bicuspid aortic valve (BAV) have been excluded in many transcatheter aortic valve replacement (TAVR) trials resulting in very limited data with regards to its safety and efficacy. METHODS: We searched electronic databases including Cochrane Database of Systematic Reviews, MEDLINE and EMBASE for all studies including case series, and original reports published before December 2018 that assessed outcomes following TAVR in BAV stenosis. We also included studies that had patients with TAV for comparison. Pooled effect size was calculated with a random-effect model and weighted for the inverse of variance, to compare outcomes post-TAVR between BAV and TAV. The heterogeneity of effect estimates across the studies was assessed using I2. Publication bias was assessed with funnel plots. Statistical analysis was performed using SPSS version 24 (IBM Corp., SPSS Statistics for Windows, Version 24.0. Armonk, NY.). RESULTS: A total of 19 studies describing 1,332 patients with BAV and 3,610 with TAV. There was no significant difference in the30-day mortality between patients with BAV and TAV [odds ratio (OR): 1.18, 95% confidence interval (CI): 0.7-1.7, P=0.41, I2=0]. One-year mortality rate in the BAV population was 13.1% compared to 15.4% in the TAV patients (P=0.75). Patients with BAV had significantly more moderate to severe paravalvular leak (PVL) post TAVR (PVL ≥3) 8.8% vs. 4.2% in TAV patients (OR: 1.478, 95% CI: 1.000-2.184, P=0.050, I2=0. Device success was significantly higher in TAV patients compared to BAV patients 93.5% vs. 87% (OR: 0.63, 95% CI: 0.49-0.86, P=0.003). CONCLUSIONS: TAVR in patients with BAV is associated with a high incidence of paravalvular regurgitation with a comparable 30-day mortality rate to TAV patients. The use of newer generation valve prosthesis improved outcomes.
Authors: David R Holmes; Michael J Mack; Sanjay Kaul; Arvind Agnihotri; Karen P Alexander; Steven R Bailey; John H Calhoon; Blase A Carabello; Milind Y Desai; Fred H Edwards; Gary S Francis; Timothy J Gardner; A Pieter Kappetein; Jane A Linderbaum; Chirojit Mukherjee; Debabrata Mukherjee; Catherine M Otto; Carlos E Ruiz; Ralph L Sacco; Donnette Smith; James D Thomas Journal: J Am Coll Cardiol Date: 2012-01-31 Impact factor: 24.094
Authors: Martin B Leon; Craig R Smith; Michael Mack; D Craig Miller; Jeffrey W Moses; Lars G Svensson; E Murat Tuzcu; John G Webb; Gregory P Fontana; Raj R Makkar; David L Brown; Peter C Block; Robert A Guyton; Augusto D Pichard; Joseph E Bavaria; Howard C Herrmann; Pamela S Douglas; John L Petersen; Jodi J Akin; William N Anderson; Duolao Wang; Stuart Pocock Journal: N Engl J Med Date: 2010-09-22 Impact factor: 91.245
Authors: Craig R Smith; Martin B Leon; Michael J Mack; D Craig Miller; Jeffrey W Moses; Lars G Svensson; E Murat Tuzcu; John G Webb; Gregory P Fontana; Raj R Makkar; Mathew Williams; Todd Dewey; Samir Kapadia; Vasilis Babaliaros; Vinod H Thourani; Paul Corso; Augusto D Pichard; Joseph E Bavaria; Howard C Herrmann; Jodi J Akin; William N Anderson; Duolao Wang; Stuart J Pocock Journal: N Engl J Med Date: 2011-06-05 Impact factor: 91.245
Authors: Bo Fu; Qingliang Chen; Feng Zhao; Zhigang Guo; Nan Jiang; Xu Wang; Wei Wang; Jiange Han; Li Yang; Yanbo Zhu; Yanhe Ma Journal: Ann Transl Med Date: 2020-07