Alfonso Ielasi1, Elisabetta Moscarella2, Antonio Mangieri3, Francesco Giannini3, Didier Tchetchè4, Won-Keun Kim5, Jean-Malte Sinning6, Uri Landes7, Ran Kornowski7, Ole De Backer8, Georg Nickenig6, Chiara De Biase4, Lars Søndergaard8, Federico De Marco9, Francesco Bedogni9, Marco Ancona10, Matteo Montorfano10, Damiano Regazzoli11, Giulio Stefanini11, Stefan Toggweiler12, Corrado Tamburino13, Sebastiano Immè14, Giuseppe Tarantini15, Horst Sievert16, Ulrich Schäfer17, Jörg Kempfert18, Jochen Wöehrle19, Azeem Latib20, Paolo Calabrò2, Massimo Medda21, Maurizio Tespili21, Antonio Colombo22. 1. Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy, Italy. Electronic address: alielasi@hotmail.com. 2. Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy. 3. GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy. 4. Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France. 5. Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany. 6. Cardiology Department, University Hospital Bonn, Bonn, Germany. 7. Cardiology Department, Rabin Medical Center, Petah Tikva, Israel. 8. The Heart Center-Rigshospitalet, Copenhagen, Denmark. 9. Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy. 10. San Raffaele Scientific Institute, Milan, Italy. 11. Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy. 12. Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland. 13. Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy. 14. Centro Cuore Morgagni, Catania, Italy. 15. Interventional Cardiology Unit, University of Padova, Italy. 16. Cardiovascular Center Frankfurt, Frankfurt, Germany and Anglia Ruskin University, Chelmsford, United Kingdom. 17. UKE, Hamburg, Hamburg, Germany. 18. Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany. 19. Ulm University, Ulm, Germany. 20. Department of Cardiology, Montefiore Medical Center, NY, New York, United States of America; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa. 21. Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy, Italy. 22. GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy; EMO GVM Centro Cuore Columbus, Milan, Italy.
Abstract
BACKGROUND: Although bicuspid aortic valve (BAV) is not considered a "sweet spot" to trans-catheter aortic valve replacement (TAVR), a certain number of BAV underwent TAVR. Whether BAV phenotype affects outcomes following TAVR remains debated. We aimed at evaluating the impact of BAV phenotype on procedural and clinical outcomes after TAVR using new generation trans-catheter heart valves (THVs). METHODS: patients included in the BEAT registry were classified according to the BAV phenotype revealed at multi-slice computed tomography (MSCT) in type 0 (no raphe) vs. type 1 (1 raphe). Primary end-point was Valve Academic Research Consortium-2 (VARC-2) device success. Secondary end-points included procedural complications, rate of permanent pacemaker implantation, clinical outcomes at 30-day and 1-year. RESULTS: Type 0 BAV was present in 25(7.1%) cases, type 1 in 218(61.8%). Baseline characteristics were well balanced between groups. Moderate-severe aortic valve calcifications at MSCT were less frequently present in type 0 vs. type 1 (52%vs.71.1%,p = 0.05). No differences were reported for THV type, size, pre and post-dilation between groups. VARC-2 success tended to be lower in type 0 vs. type 1 BAV (72%vs86.7%;p = 0.07). Higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 group (24%vs6%,p = 0.007). No differences were reported in the rate of post-TAVR moderate-severe aortic regurgitation and clinical outcomes between groups. CONCLUSIONS: Our study confirms TAVR feasibility in both BAV types, however a trend toward a lower VARC-2 device success and a higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 BAV.
BACKGROUND: Although bicuspid aortic valve (BAV) is not considered a "sweet spot" to trans-catheter aortic valve replacement (TAVR), a certain number of BAV underwent TAVR. Whether BAV phenotype affects outcomes following TAVR remains debated. We aimed at evaluating the impact of BAV phenotype on procedural and clinical outcomes after TAVR using new generation trans-catheter heart valves (THVs). METHODS:patients included in the BEAT registry were classified according to the BAV phenotype revealed at multi-slice computed tomography (MSCT) in type 0 (no raphe) vs. type 1 (1 raphe). Primary end-point was Valve Academic Research Consortium-2 (VARC-2) device success. Secondary end-points included procedural complications, rate of permanent pacemaker implantation, clinical outcomes at 30-day and 1-year. RESULTS: Type 0 BAV was present in 25(7.1%) cases, type 1 in 218(61.8%). Baseline characteristics were well balanced between groups. Moderate-severe aortic valve calcifications at MSCT were less frequently present in type 0 vs. type 1 (52%vs.71.1%,p = 0.05). No differences were reported for THV type, size, pre and post-dilation between groups. VARC-2 success tended to be lower in type 0 vs. type 1 BAV (72%vs86.7%;p = 0.07). Higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 group (24%vs6%,p = 0.007). No differences were reported in the rate of post-TAVR moderate-severe aortic regurgitation and clinical outcomes between groups. CONCLUSIONS: Our study confirms TAVR feasibility in both BAV types, however a trend toward a lower VARC-2 device success and a higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 BAV.
Authors: Ahmed Elkoumy; John Jose; Christian J Terkelsen; Henrik Nissen; Sengottuvelu Gunasekaran; Mahmoud Abdelshafy; Ashok Seth; Hesham Elzomor; Sreenivas Kumar; Francesco Bedogni; Alfonso Ielasi; Santosh K Dora; Sharad Chandra; Keyur Parikh; Daniel Unic; William Wijns; Andreas Baumbach; Darren Mylotte; Patrick Serruys; Osama Soliman Journal: J Clin Med Date: 2022-01-15 Impact factor: 4.241